Cerebrospinal Fluid (CSF) Leak
A CSF leak is a serious condition. This occurs when fluid around the brain leaks out through the nose. A sign of a CSF leak is clear, watery drainage leaking from the nose, usually just from one side. The drainage tends to taste salty or metallic. It may get worse when straining or bending forward. In most cases the cause is unknown, but it can occur after a traumatic event to the head or neck.
To diagnose a CSF leak, the draining fluid is collected and tested for a protein called beta-2 transferrin, which is only present in CSF. In addition, radiology studies are needed to help determine where the leak is coming from. Often, a CT scan is all that is needed. In some cases, an MRI or even a cisternogram is also needed. These studies helps show the exact location of the CSF leak. The CSF leak should be surgically corrected, because there is a risk of meningitis – an infection of the membranes surrounding the brain when there is an open communication between the brain and the nose.
A CSF leak is best handled by a rhinologist. The surgery requires careful and delicate work around the top of your sinuses and the bottom of your brain, so someone skilled in endoscopic techniques and comfortable with the anatomy in this area should be performing the procedure. I often work with a neurosurgeon during these cases so that we can comprehensively address all aspects that might be contributing to the underlying cause of the CSF leak.