The human brain is cushioned by clear, colorless fluid called cerebrospinal fluid (CSF). Flowing through the ventricles in the brain, this important fluid protects the brain tissue from mechanical trauma and infections. Defects in the skull base that lies beneath the brain at the roof of the nose can lead to tears in the tissue surrounding the brain, called the dura. These dura tears can lead to CSF leaks into the nose. Nasal CSF leaks can occur spontaneously or as a result of trauma or previous sinonasal surgery. This is a very serious condition, and these tears must be repaired in order to prevent meningitis, an infection of the brain tissues. The Johns Hopkins Sinus Center is the regional referral center of choice for these delicate surgical repairs.
Symptoms of CSF leaks may include:
• A constant dripping of clear fluid from the nose
• Severe headaches
• Meningitis
Leaks of CSF are usually caused by the following:
• Blunt trauma to the head/and or ears
• Prior sinonasal surgery
• Spontaneous leaks can occur in patients with elevated intracranial pressure
Diagnosing CSF leaks will include the following:
- Your doctor will ask for a complete medical history and will perform a thorough physical examination.
- Nasal endoscopy is performed on all patients in the clinic using a small lighted scope with a camera. This painless procedure allows our sinus doctors to examine the inside of the nose and sinuses and plan the endoscopic surgery. In some cases the doctor may be able to identify the area of the leak in the office.
- Sinus computed tomography (CT) scans and in some cases MRI scans are obtained for patients. These scans provide a detailed image of the skull base and sinuses and help your doctor to identify the CSF leak.
- Your doctor will have you collect a sample of the fluid to test it in order to determine if it is CSF. If it is, your doctor will recommend a surgical repair called CSF Leak Closure in most cases. If the leak is not closed, this condition predisposes patients to infection (meningitis).
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