Cerebrospinal fluid leak treatment
A cerebrospinal fluid leak is the release of fluid from the membrane of the spine due to its rupture or the hole. Doctors use a brain or spine MRI with contrast and lumbar puncture with CT myelography to determine the correct diagnosis. Depending on the severity, doctors can advise from conservative treatment (medications) to surgical operation to close the opening.
Cerebrospinal fluid (CSF) covers the brain and spinal cord, protecting them from injury and damage. CSF leak is a relatively rare medical disorder. However, the leakage may occur when external factors act on the spine. In 90% of cases, this happens due to trauma (accidents or unsuccessful medical intervention). Physicians suggest that the remaining 10% of patients can have intracranial hypertension, skull defects, and connective tissue diseases.
Based on the statistics, approximately five people out of 100,000 develop this condition. Neuropathologists distinguish two main types of this disorder:
- Spinal CSF leak - occurs in any part of the spine.
- Cranial CSF leak - occurs inside the skull.
With a small leak, the symptoms are of little concern, but when the leak is large, it causes a decrease in pressure inside the skull (intracranial hypotension) and causes several more prominent symptoms:
- Debilitating sharp headache, as a rule, in the back of the head with the transition to the neck.
- Nausea, vomiting, vertigo, ringing in the ears.
- Sensitivity to light or sound.
- Heaviness or pressure in the head.
- Worsening of symptoms in an upright position and with physical exertion.
Symptoms of a cranial CSF leak include the discharge of clear fluid from the nose or ears. That is the primary concern for almost all patients with cerebrospinal fluid leaks presented to the ENT doctor.
With a mild hole, doctors limit themselves to bed rest, fluids, and caffeine to fix the problem. More severe leaks need more effective therapy. For example, an epidural blood patch (the patient's blood is injected into the spinal canal and covers the area of damage). Instead of the patient's blood, doctors can use a special sealant for the same purpose.
But more frequently, CSF leaks will require surgical treatment. Neurosurgeons perform operations when other treatments have failed; this may be suturing or grafting. The procedure aims to close the opening and prevent CSF discharge. As a new minimally invasive treatment, doctors use transvenous embolization, when vessels are glued from the inside through a catheter, preventing fluid from escaping.
CSF leakage has a favourable prognosis, with 98% of patients recovering completely.
Where can I get Cerebrospinal fluid leak treatment?
What are the best clinics for Cerebrospinal fluid leak treatment?
Who are the best doctors for Cerebrospinal fluid leak?
Prof. Dr. med. Bernhard Meyer from University Hospital rechts der Isar Munich
Dr. med. Peter Madjurov from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Thomas Gasser from Beta Clinic Bonn
Prof. Dr. med. Marcus Czabanka from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Jorg-Christian Tonn from University Hospital Ludwig-Maximilians Munich