Conventional Medical Treatments for Cerebrospinal Fluid (CSF) Leaks

What is a CSF leak?

The brain and spinal cord are protected by three membranes (meninges). When the outermost layer of the meninges, the dura, is injured or punctured — often as a result of a head injury, certain medical procedures, or an increase of pressure in the skull — a cerebrospinal fluid (CSF) leak may occur. Cerebrospinal fluid is a clear liquid that flows in and around the brain and spinal cord to protect from injury and transfer nutrients.

Cerebrospinal fluid leaks are categorized according to the location of the leak: Spinal CSF leaks originate from the dura around the spinal column, whereas cranial CSF leaks originate from the dura around the skull. Symptoms of a CSF leak vary and may include headache, tinnitus, nasal drainage, ear drainage, dizziness, nausea, and/or behavioral changes.

Conventional medical treatments

Treatment for a CSF leak is dependent on the location and severity of the leak. Some CSF leaks simply improve with rest, whereas others require treatment.

Medications

Certain medications may be prescribed to treat symptoms or prevent complications of CSF leaks.

• Medications to decrease the production of spinal fluid
  Medications, such as steroids, diuretics, or carbonic anhydrase inhibitors, may be prescribed to slow down the production of spinal fluid.
• Antibiotics
  Antibiotics can help prevent or treat infections associated with CSF leaks. Antibiotic treatment helps prevent complications such as meningitis from occurring.
• Pain medications
  Pain medication may be prescribed if over-the-counter pain medications fail to reduce pain associated with a CSF leak.

Epidural blood patch

Blood patch injections are a common treatment for CSF leaks. An epidural blood patch involves injecting an individual’s own blood into their spinal canal. This is done with imaging guidance. The blood then clots and acts as a patch for the leak.

Fibrin sealant

A plug of fibrin (fibrous protein in blood plasma) sealant can also be injected into the spinal canal to patch a CSF leak. This procedure is also done with imaging guidance.

Trans-venous embolization

In cases of CSF-venous fistulas (abnormal connections in the spine that allow CSF to leak into paraspinal veins), trans-venous embolization can be performed to stop the leak. Trans-venous embolization involves plugging the leak from inside the affected vein.

Surgery

If less invasive treatments are unsuccessful, surgery to repair the dura (duraplasty) may be necessary to stop the leak. The type of surgery is dependent on the location and severity of the CSF leak. Examples of surgeries used for CSF leak repair include endoscopic nasal CSF closure and ear CSF closure.

Additional source: Spinal CSF Leak Foundation