Cerebrospinal Fluid (CSF) Leak Program

A spinal CSF leak occurs when a hole or defect in the dura — the membrane that holds cerebrospinal fluid in place around the spinal cord — allows fluid to escape. A tear can result from:

• Abnormal venous connections – an abnormal connection between the sac that contains the fluid and an adjacent blood vessel
• Bone spurs
• Medical procedures, such as epidural placement or spinal surgery
• Traumatic injuries

Some individuals are more likely to develop spontaneous or recurring CSF leaks due to underlying medical conditions that weaken the dura, including:

• Connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome
• Intracranial hypertension
• Obesity
• Obstructive sleep apnea
• Prior head, sinus or spinal surgery

CSF leaks can cause chronic, debilitating symptoms that are often difficult to diagnose. When cerebrospinal fluid escapes, pressure around the spinal cord decreases as the protective cushion of fluid depletes. This leads to chronic headaches and other debilitating symptoms, including:

• Cognitive changes, brain fog or difficulty concentrating
• Dizziness, especially when sitting or standing upright
• Double or blurry vision
• Nausea
• Neck pain or stiffness
• Ringing in the ears or hearing loss
• Sensitivity to light
• Spontaneous or severe headaches, especially when sitting or standing upright

Our specialists use advanced imaging and diagnostic techniques to locate the source of the leak and determine the best treatment approach. Prompt, accurate diagnosis is critical to preventing serious complications and starting effective therapy.

Diagnostic testing may include:

• CT myelogram – uses a special dye and imaging to identify spinal fluid leaks
• Digital subtraction myelogram – helps visualize leaks that are difficult to detect
• Dynamic CT myelogram – captures images while the fluid is moving to pinpoint fast or intermittent leaks
• MRI of the brain and spine – detects changes in brain position or fluid levels caused by cerebrospinal fluid loss

Under fluoroscopic guidance, your own blood, surgical glue or a combination is injected near the leak. Multiple patches may be placed if the precise leak site is unclear.

For complex spinal CSF leaks or those caused by bone spurs, a spine surgeon can repair the leak with stitches, clips or adhesives, and remove problematic spurs.

Many of the surgeries can be performed in a minimally invasive fashion with endoscopy. 

Some spinal CSF leaks are caused by cerebrospinal fluid draining too quickly into the venous system through a fistula, which is an abnormal connection that can form between spinal fluid and a nearby vein. In these cases, an endovascular neurosurgeon can use an image-guided, minimally invasive technique to navigate a small catheter to the fistula and seal the leak using surgical glue.

If a fistula cannot be closed through embolization, a neurosurgeon can surgically disconnect the abnormal venous pathway to restore normal CSF flow.