CSF rhinorrhea closure (CSF Leaks)

What is a CSF Leak?

CSF is the protective fluid which surrounds the brain and spinal cord. There is a barrier of bone and other tissues which separate the brain from the nasal cavity. Any breach in this barrier would cause this CSF to leak out of the nose. This condition is called CSF rhinorrhea.
A CSF leak is a serious and often incapacitating medical condition known as Cerebrospinal fluid (CSF) rhinorrhea. It can occur in the head as a result of trauma, surgery, an underlying disorder like tutors or spontaneously. The majority of these leaks stop on their own, but surgery may be needed if the leaking continues after conservative management.

What are the symptoms of CSF rhinorrhea?

Clearwater dripping from the nose especially on bending forward.

Headache

Spread of infection from the nose to the CSF can lead to Meningitis presenting as severe headache, high-grade fever and neck stiffness.

If you have any of the above symptoms, then consult the Best ENT doctor in Bangalore immediately.

Diagnosing CSF Rhinorrhea

CSF rhinorrhea diagnosis requires testing the drainage from the nose for a protein called Beta-2 transferrin which is only found in brain fluid. The discharge is collected and sent for laboratory tests to determine if it is cerebrospinal fluid.
Once there is a diagnosis, the evaluating doctor may order several other tests to determine the location of the leak. A CT scan and MRI scan of the brain and paranasal sinuses often reveals the source of the leak and helps the surgeon plan any needed surgery.
Additional tests may be required such as lumbar puncture (spinal tap), where dye is used to help pinpoint the area of the leak.
You may also have to undergo evaluations by an Ophthalmologist to rule out high intracranial pressure. Tests may include an eye exam and lumbar punctures to measure the pressure of the fluid surrounding your brain and spinal cord.

How is CSF Rhinorrhea Treated?

Patients with symptoms of CSF Rhinorrhea should still visit ENT specialist in Bangalore due to the increased risk of meningitis that is associated with CSF leaks. It is important to first localise the leak and identify the cause of the leak. If its not a major breach then it can be treated conservatively with medication, adequate rest. It is mandatory to avoid straining on stools, coughing, sneezing, lifting weights as these activities can raise the intracranial pressure and the leak can increase. This will prevent the leak from closing spontaneously.
Looking for the best hospital for CSF Rhinorrhea treatment in Bangalore? Visit Sakra World Hospital to consult the ENT doctor in Bangalore.

If conservative treatment doesn’t work then surgery is necessary to repair cranial cerebrospinal fluid leaks. There are two ways to approach the leak - a neurosurgical approach through the skull by retracting the brain or nasal endoscopic procedure through the nose by ENT - skull base surgeon.

Computer-Assisted Surgery

Sakra World Hospital has extensive experience in nasal endoscopic and Skull base surgeries which are much less invasive than traditional surgical methods. This surgery is performed using nasal endoscopes and endoscopic instruments. The doctor places these tools up the nostrils and into the nose and sinuses to reach the defect in the skull base. These surgeries are done using a piece of special advanced equipment called Computer Assisted Surgery or Navigation Assisted Surgery which helps in exact localisation of the defect and also the instruments which are used. These surgeries are very delicate because of the vital structures around which the procedure is done, especially the brain, eye, optic nerve, major blood vessels and nerves. The doctor may use small pieces of fat from your abdomen, fascia and/ or muscle to repair the leak and also tissue glue. The nose will be packed with a medicated sponge-like material after the closure of the leak
Surgery usually requires a hospital stay of 3 to 4 days. Patients will be on medications like antibiotics, for pain relief and to reduce the CSF pressure.

Some people can have multiple leaks due to weak bone or due to persistent raised intracranial pressure. These patients will need further medications or might require multiple procedures.