What is the treatment for a cerebrospinal fluid (CSF) leak?

Treatment options for a CSF leak depend on its cause and the location of the leak (cranial vs spine). In general, conservative treatments are usually tried first for leaks at either location.

Conservative treatments

  • Bed rest (days to up to 2 weeks)
  • Hydration (2 to 3 quarts)
  • IV caffeine infusions
  • Saline infusions

Additional instructions for patients with cranial CSF leaks are to avoid coughing, sneezing, nose blowing, heavy lifting and to take stool softeners to avoid straining during bowel movements.

Surgical treatments

If conservative treatments are not successful in stopping the leak, more invasive procedures are tried.

Cranial CSF leaks. Repair of cranial CSF leaks depend on the size and the location of the leak. CSF leaks from your nose can usually be repaired using nasal endoscopy (using a camera and a thin long lens through your nostril). CSF leaks into your ear will usually need the use of a microscope. Options including using a synthetic graft; using a piece of your own tissue including fat, muscle, and mucosal lining; or using a flap of tissue. In addition, various surgical adhesives (glues) and bony cement could also be used. If hydrocephalus is suspected to be the cause of the CSF leak, a lumbar drain may also be placed in the lower back to decrease intracranial pressure.

Spinal CSF leaks. After conservative treatments have been tried, an epidural blood patch is the most common treatment for spinal CSF leaks. In this procedure, your own blood is injected into the spinal canal. The blood clot that forms creates a seal to stop the leak. If several attempts of epidural blood patches do not work, other grafting materials, such as epidural fibrin glue, or fat or muscle patches, may be tried. If these methods are not successful, other surgical approaches to repair the leak include using stitches (sutures) or aneurysm clips.

What precautions should I take following a CSF leak repaired?

Your doctor will give you additional instructions, but these are also some reasonable precautions to follow for 4 to 6 weeks after your CSF leak repair:

  • Avoid lifting anything over 10 pounds
  • Avoid bending, lifting, stretching and twisting
  • Avoid straining to have bowel movements; a stool softener is often prescribed
  • Avoid coughing and sneezing, but if you must, do so with your mouth open
  • Do not blow your nose
  • Avoid use of straws
  • Keep your back straight during all movements (bend at knees and hips)

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