CSFlekkage

CSFlekkage, or cerebrospinal fluid (CSF) leakage, is the escape of CSF from the subarachnoid space due to a breach in the dura mater. This can occur after trauma to the skull or spine, as a result of medical procedures such as lumbar puncture or spinal anesthesia, following neurosurgical operations, or spontaneously due to weakness in the dura.

Causes and risk factors include skull base or spinal fractures, endoscopic skull base or sinus surgery, connective tissue disorders that affect dural integrity, and spontaneous leaks from dural defects or meninges-related conditions. Leaks may present with persistent headaches that worsen when upright, clear nasal or ear discharge, a salty or metallic taste in the mouth, neck stiffness, nausea, and light sensitivity. Infections such as meningitis are a potential complication if the CSF communicates with the nasal or ear passages.

Diagnosis involves a combination of clinical assessment and laboratory testing. The presence of clear fluid that tests positive for beta-2 transferrin from nasal or ear discharge is highly specific for CSF. Imaging, including brain and spine MRI, CT cisternography, or MR cisternography, helps locate the leak and assess associated pathology. Endoscopic examination may visualize the defect.

Management commonly starts with conservative measures, as many leaks heal spontaneously within days to weeks. This can include bed rest, adequate hydration, caffeine, and analgesia. If conservative therapy fails or the leak is high-flow or persistent, interventions such as epidural blood patch, targeted fibrin sealant, or surgical repair of the skull base with dural closure or grafts may be planned. Prognosis varies with cause and leak size; persistent leaks require close monitoring due to meningitis risk. Prevention focuses on careful technique during procedures and prompt treatment of recognized leaks.