Materiały źródłowe

• #1 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Cerebrospinal fluid (CSF) is a clear protein- and glucose-rich liquid in the subarachnoid space of the central nervous system. A leak in this system, therefore, can be detrimental to brain blood supply and function and can increase the risk of direct trauma to brain parenchyma due to loss of fluid cushion. […] The CSF leak occurs when there is a tear or hole in the dura mater, the outermost layer of the meninges that protect the central nervous system, communicating the subarachnoid space with the epidural space and, sometimes, with the skin establishing a connexion between the CNS and the external environment. […] Spinal CSF leaks are currently recognized to occur through three primary mechanisms: meningeal diverticula, ventral dural tears, and CSF-venous fistulas (CVFs). […] The mechanism of CSF leaks after head trauma and surgical procedures is mainly due to the breach in the intervening layers of mucosa, bone, dura, and arachnoid membrane, which results in rhinorrhea – the flow of CSF into the nose.

• #2 Cerebrospinal Fluid Leak – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30844184/

  Cerebrospinal fluid (CSF) is a clear, colorless liquid found in the subarachnoid space (SAS) that fills the neuroaxis cavities and surrounds the central nervous system (CNS). […] The CSF leak occurs when there is a tear or hole in the dura mater, the outermost layer of the meninges that protect the central nervous system, communicating the subarachnoid space with the epidural space and, sometimes, with the skin establishing a connexion between the CNS and the external environment. […] A leak can be detrimental to brain blood supply and function and can increase the risk of direct trauma to brain parenchyma due to loss of fluid cushion. Open communication of the subarachnoid space with CSF leak also presents a pathway for life-threatening CNS infection, including meningitis. Therefore, the presence of signs and symptoms of a CSF leak indicates the need for further evaluation and management.

• #3 Cerebrospinal Fluid (CSF) Leak: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/ochspine/cerebrospinal-fluid-csf-leak

  Cerebrospinal fluid leaks are a rare but serious condition that may lead to long-term side effects or health complications if left untreated. […] There are several causes of cranial and spinal CSF leaks, which may be brought on by nonsurgical trauma, surgical trauma, or even spontaneously. […] Some cranial and spine CSF leaks may not have an identifiable cause. […] If the condition is left untreated, complications can develop from a chronic or ongoing CSF leak. […] Serious complications include: Meningitis is an infection in the brain that causes inflammation of the lining of the brain and spinal cord. […] Other complications may include: Neck pain, Low-pressure headaches, Tinnitus, Loss of smell and taste, Palpable fluid collection in the region of the leak.

• #4 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Ventral dural tears are more commonly caused by calcified disk protrusions or sharp endplate osteophytes that incise the dura, producing a longitudinally oriented tear. […] In this entity, there is a direct connection between the spinal subarachnoid space and the draining paraspinal vein that allows rapid loss of CSF into the venous circulation.

• #5 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Cerebrospinal fluid (CSF) surrounds the brain and spinal cord and provides a cushion to protect them from injury. When there is a hole or tear in the outermost layer, a CSF leak occurs. The hole or tear in this outer layer, called the dura mater, allows some of the fluid to escape. […] There are two distinct types of CSF leaks: spinal CSF leaks and cranial CSF leaks. Each type has different symptoms, causes and treatments. […] A spinal CSF leak occurs anywhere in the spinal column. […] A cranial CSF leak occurs in the skull, and often causes symptoms such as clear fluid leaking from the nose or ear. […] Some CSF leaks may heal with bed rest and other conservative treatment. Many CSF leaks need a patch to cover the hole or surgery to repair the leak. […] Spinal CSF leaks may be caused by: A spinal tap, also called a lumbar puncture. An epidural in the spine for pain relief, such as during labor and delivery. An injury to the head or spine. Bone spurs along the spine. Irregularities of the dura mater around the nerve roots in the spine. Irregular connections between dura mater and veins. These are referred to as CSF-venous fistulas. Prior surgery on the spine.

• #6 Cranial cerebrospinal fluid leaks – UpToDate

  https://www.uptodate.com/contents/cranial-cerebrospinal-fluid-leaks

  Cranial cerebrospinal fluid leak is a pathologic condition caused by an abnormal communication between the subarachnoid and extradural spaces. CSF flows externally down a pressure gradient to cause clear rhinorrhea or otorrhea, the leakage of CSF into the nose or ear. The most common causes of cranial CSF leaks are craniofacial trauma and intracranial surgical procedures. CSF leak may also be spontaneous, due to intracranial tumors, idiopathic intracranial hypertension (IIH), or congenital skull defects. […] CSF leaks causing spontaneous intracranial hypotension (SIH) are typically due to a leak in the spinal canal.

• #7 Cerebrospinal Fluid (CSF) Leak: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16854-cerebrospinal-fluid-csf-leak

  If the leak is large enough to cause intracranial hypotension, your brain will sink downward in your skull, putting too much pressure on its lower sections. That can disrupt how those parts of your brain work, causing symptoms ranging from minor and barely noticeable to severe and unbearable. […] Experts estimate that about 90% of CSF leaks happen because of injuries. The remaining 10% happen spontaneously or for unknown reasons. […] Many injuries can cause CSF leaks. These include injuries to your face, head, neck or spine. A common example of this is injuries from car crashes. […] In about 10% of cases, CSF leaks happen for unknown reasons. However, experts have connected this problem to a few other medical conditions. […] The treatments you receive depend most on what caused the CSF leak and its location.

• #7 Cerebrospinal Fluid (CSF) Leak: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16854-cerebrospinal-fluid-csf-leak

  A cerebrospinal fluid leak (CSF) is when you’re leaking the fluid that surrounds your brain and spinal cord. CSF leaks can often cause severe symptoms, but this condition is very treatable, and up to 98% of people with it will recover. […] A cerebrospinal fluid leak can affect many body systems, including balance, vision, hearing, brain function and more. Cerebrospinal fluid leak can cause a wide range of symptoms, affecting your senses, movement and more. […] A cerebrospinal fluid leak is when the fluid surrounding your brain and spinal cord leaks out from where its supposed to be. If the leak is large enough, it can cause severe symptoms that make it hard or even impossible to go about your life as usual. […] Having a CSF leak causes a drop in fluid pressure inside your head. That causes a condition known as intracranial hypotension (intracranial means inside your skull and hypotension means lower than normal pressure).

• #8 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Cranial CSF leaks may be caused by: A head injury. Sinus surgery. Increased pressure in the brain. Malformations of the inner ear. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #9 Cerebrospinal fluid leak – Wikipedia

  https://en.wikipedia.org/wiki/Cerebrospinal_fluid_leak

  Cerebrospinal fluid is produced by the choroid plexus in the ventricles of the brain and contained by the dura and arachnoid layers of the meninges. The brain floats in CSF, which also transports nutrients to the brain and spinal cord. As holes form in the spinal dura mater, CSF leaks out into the surrounding space. The CSF is then absorbed into the spinal epidural venous plexus or soft tissues around the spine. Due to the sterile conditions of the soft tissues around the spine, there is no risk of meningitis. […] Lack of CSF pressure and volume can allow the brain to sag and descend through the foramen magnum (large opening) of the occipital bone, at the base of the skull. The lower portion of the brain is believed to stretch or impact one or more cranial nerve complexes, thereby causing a variety of sensory symptoms. A rare form of dementia known as brain sagging dementia may be caused by a sagging brain, a characteristic of intracranial hypotension.

• #9 Cerebrospinal fluid leak – Wikipedia

  https://en.wikipedia.org/wiki/Cerebrospinal_fluid_leak

  A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneous (primary), having no known cause (sCSF leak), or nonspontaneous (secondary) where it is attributed to an underlying condition. Causes of a primary CSF leak are those of trauma including from an accident or intentional injury, or arising from a medical intervention known as iatrogenic. A spinal CSF leak can be caused by one or more meningeal diverticula or CSF-venous fistulas not associated with an epidural leak. A spontaneous spinal cerebrospinal fluid leak may occur sometimes in those with predisposing heritable connective tissue disorders including Marfan syndrome and Ehlers-Danlos syndromes. A loss of CSF greater than its rate of production leads to a decreased volume inside the skull known as intracranial hypotension.

• #10

  https://journals.lww.com/sjoh/fulltext/2021/23030/pathophysiology_of_skull_base_defects_and.1.aspx

  Cerebrospinal fluid (CSF) leak is a rare pathology with many etiologies. It can be spontaneous, congenital, iatrogenic, or traumatic. A skull base defect may occur along the anterior or lateral skull base manifesting as CSF rhinorrhea or CSF otorrhea. It occurs whenever there is a mucosal, bony, and dural defect. These defects could lead to communication between the nasal cavity, the paranasal sinuses, or the middle ear cavity and the subarachnoid space. Idiopathic intracranial hypertension (IIH), obesity, obstructive sleep apnea (OSA), and malignancies are well-known conditions that contribute to the development of a CSF leak. […] In this article, we review the pathophysiology of each etiology. […] The exact cause of IIH is still unknown. However, some mechanisms have been hypothesized about the impaired hydrodynamics of CSF. Researchers believe that cerebral venous hypertension and altered venous outflow are the main mechanisms in the development of IIH. Cerebral venous hypertension and altered venous outflow lead to dysfunctional arachnoid granulations and impaired CSF absorption causing elevated ICP. Elevated ICP with its dural pulsations can exert direct pressure over the skull base causing bone thinning and resorption. Then, thin areas of the skull base could completely erode, especially in cases of hyperpneumatization with subsequent brain herniation and CSF leak.

• #11

  https://journals.lww.com/sjoh/fulltext/2021/23030/pathophysiology_of_skull_base_defects_and.1.aspx

  There is a well-recognized association between body mass index (BMI) and IIH. More than 70% of IIH patients are obese, and weight loss is well known to improve symptoms of elevated ICP and CSF opening pressures. OSA is more prevalent in patients with spontaneous CSF leak in comparison to other CSF leak patients and the general population. Given the strong association between spontaneous CSF leak due to IIH and OSA, many studies have suggested the need to screen all patients with spontaneous CSF leak for symptoms of both IIH and OSA. […] The dura membrane is an important structure that protects the entire central nervous system. In a postmortem study, age and female gender had a negative correlation with dural thickness. In other retrospective studies, the thickness of the skull base was found to be greater in patients with traumatic CSF leaks and normal control subjects than in patients with spontaneous CSF, especially in the ethmoid roof, lateral lamella, and anterior face of the sella. Moreover, there is a significant correlation between the thickness of anterior and lateral skull base in patients with spontaneous CSF rhinorrhea.

• #12

  https://journals.lww.com/sjoh/fulltext/2021/23030/pathophysiology_of_skull_base_defects_and.1.aspx

  The lateral recess of the sphenoid sinus and the cribriform plate of the ethmoid bone are the most common sites of meningoceles and spontaneous CSF leaks. A defect in the middle cranial fossa can expose the dura to the middle ear through the tegmen, causing spontaneous CSF otorrhea and/or encephalocele. […] CSF leak is a rare pathology with many etiologies. It can be spontaneous, congenital, iatrogenic, or traumatic. A skull base defect may occur along the anterior or lateral skull base manifesting as CSF rhinorrhea or CSF otorrhea, and multiple defects could happen simultaneously in the same patient. These defects could lead to communication between the sinonasal or the middle ear spaces and the subarachnoid space, causing clear rhinorrhea or otorrhea, respectively. Knowing the pathophysiology of different entities should help the treating team in managing patients with appropriate investigations, medications, and surgical interventions, to prevent potential complications and to ensure successful repair.

• #13 Spinal CSF Leak | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/spinal-csf-leak/

  Cerebral spinal fluid (CSF) is a clear, colorless bodily fluid that acts as a natural shock absorber for the brain and spine and protects them from the jolts and knocks the body endures throughout the day. […] Spinal CSF leaks occur when the fluid escapes or leaks out of the dural sac. The loss of this fluid causes the brain to lose its buoyancy and sag inside the skull. This results in a low volume of CSF remaining around the brain and spinal cord, also referred to as intracranial hypotension. […] CSF leaks can occur for a number of reasons, including: Trauma (caused by an injury), An injury to the head or spine, Bone spurs along the spine, Heavy straining such as lifting heavy objects, Significant fall or motor vehicle accident, Strenuous exercise or sports, especially when new to the person, Prolonged severe coughing, Iatrogenic (caused intentionally or accidentally during a medical procedure): A lumbar puncture (spinal tap), An epidural in the spine for pain relief, such as during labor and delivery, Surgery on the spine, Spontaneously (no known cause).

• #14 CSF leak (Cerebrospinal fluid leak) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/csf-leak-cerebrospinal-fluid-leak

  Cranial CSF leaks may be caused by: A head injury. Sinus surgery. Increased pressure in the brain. Malformations of the inner ear. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain. […] Some CSF leaks improve with bed rest alone, but most need treatment. […] Treatments for spinal CSF leaks may include: Epidural blood patch. This treatment involves taking a sample of your own blood, then injecting it into the spinal canal. The blood cells form a clot, which can create a patch to cover the area where the CSF is leaking. Fibrin sealant. Fibrin sealant is special glue made from substances in human plasma that help with blood clotting. Used alone or mixed with your blood, it is injected into the spinal canal to cover the hole and stop the CSF leak. Surgery. Some CSF leaks need surgery. Surgery is performed if the other treatment options don’t work and the precise site of the leak is known. […] Other cranial CSF leaks require surgical repair.

• #15 Spinal CSF Leaks – Overview – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/overview-of-spinal-csf-leak/

  A spinal CSF leak happens when the spinal dura mater has a hole, tear, or other defect, allowing cerebrospinal fluid (CSF) to leak out of this enclosed space. This results in intracranial hypotension, a low volume of CSF remaining around the brain and spinal cord. […] Dural holes or tears can happen due to a number of reasons, whether iatrogenic, traumatic, or spontaneous. […] Iatrogenic spinal CSF leaks are caused by a medical procedure, intentionally or inadvertently. […] Spontaneous spinal CSF leaks occur with minimal or no clear precipitant. Often, these spontaneous leaks are associated with thinner dura than normal, as is seen with a number of heritable disorders of connective tissue. A dural tear may also be caused by a calcified intervertebral disc or bone spur.

• #16 What is a CSF Leak? | CSF Leak Association

  https://csfleak.uk/resource/what-is-a-csf-leak

  Many people develop a CSF leak as a result of a lumbar puncture or an epidural injection or anaesthesia, while others develop them following trauma ranging from major trauma and whiplash, to minor trauma which may otherwise have gone unnoticed. […] Sometimes a CSF leak can be an unintentional consequence of an over-draining shunt, placed for the treatment of intracranial hypertension (high pressure), or as a result of underlying intracranial hypertension that has gone undiagnosed. […] Spinal CSF leaks, particularly those resulting from trauma or occurring spontaneously, are commonly found at the thoracic spine and cervicothoracic junction. Spinal leaks have also been reported due to cervical bone spurs or other conditions affecting the vertebrae. […] Such leaks are increasingly attributed to an underlying congenital disorder, such as the Ehlers-Danlos Syndromes and other connective tissue diseases.

• #16 What is a CSF Leak? | CSF Leak Association

  https://csfleak.uk/resource/what-is-a-csf-leak

  A cerebrospinal fluid (CSF) leak is an under-diagnosed, yet often debilitating, medical condition comprising a small tear or hole in the outer membrane that contains the fluid surrounding the spinal cord and brain. Or caused by a CSF-Venous Fistula (CVF), where there is an abnormal connection between the CSF space and a vein, allowing CSF to flow out into the bloodstream. […] When the fluid leaks out of the dura at spinal level, the overall volume and pressure of fluid within the skull drops (known as intracranial hypotension), its cushioning effect is reduced, and the brain slumps. This slumping effect, also called brain sag, results in severe pain, pressure, blurred/double vision, eye pain, neck pain, hearing impairment, tinnitus, spasm, seizures and a wide range of other symptoms. […] A key characteristic of a CSF leak particularly a spinal leak is that the vast majority of symptoms, if not all, worsen markedly upon sitting or standing, but lessen substantially, and in some cases disappear completely, when lying down. The longer a leak goes untreated, the less prominent this orthostatic characteristic of symptoms may become.

• #17 Spinal CSF Leak | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/spinal-csf-leak/

  Risk factors for spinal CSF leaks include: Connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, Abnormalities of the dura mater around the nerve roots in the spine, Abnormal connections between dura mater and veins (CSF-venous fistulas). […] If your doctor suspects a CSF leak, he or she may recommend the following tests: MRI of the brain and spine: MRI scans can help confirm the presence of a leak by showing typical findings in the brain or spine and help determine the location and severity of a CSF leak. […] Initial treatment may be conservative if the symptoms are not severe. This might include bedrest, oral and IV fluids, and oral and IV caffeine. Some cases resolve without any further treatment. […] If conservative treatments have been unsuccessful, an epidural blood patch is the most common first treatment for spinal CSF leaks. In this procedure, your own blood is injected into the epidural space in the spinal canal. The blood clot that forms creates a seal to stop the leak, allowing the body to heal the tear in the dura. If several attempts of epidural blood patches do not work, other materials, such as epidural fibrin glue, NBCA (a medical grade superglue) may be tried. If these methods are not successful, other surgical approaches to repair the leak include using stitches (sutures) or aneurysm clips. […] A small percentage of patients will require surgical repair by a spinal neurosurgeon who would treat a spinal CSF leak with stitches (sutures) or aneurysm clips.

• #18 Expert Treatment for Cerebrospinal Fluid Leaks | Skull Base Conditions | Ear, Nose and Throat Services | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/services/ear-nose-and-throat-services/conditions-and-treatments/skull-base-conditions/cerebrospinal-fluid-leaks

  Weakening of the bone that can lead to encephalocele can be congenital (present at birth) or may develop slowly over time as a person ages. It can also be the result of chronic ear infections and/or prior ear surgery performed to treat ear infections or other conditions. Obesity and obstructive sleep apnea are also potential risk factors for CSF leaks due to encephalocele.

• #19 :: KJNT :: Korean Journal of Neurotrauma

  https://kjnt.org/DOIx.php?id=10.13004/kjnt.2017.13.2.63

  Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). […] Early diagnosis and proper management is imperative for it is strongly associated with a better long-term prognosis of the patients. […] After severe craniomaxillofacial trauma, the destruction of the meningeal structure may lead to the CSF leak from the subarachnoid space. […] The risk of meningitis from the traumatic CSF leak can present with high morbidity and even mortality depending on the cause and site of CSF leak. […] The traditional treatment involves intravenous antibiotics treatment as well as primary repair of dural defect if the definite injury is suspected. […] The decision of whether to observe or to surgically intervene is most likely to be dependent on the cause, site of leak, and timing of the leak.

• #20 :: KJNT :: Korean Journal of Neurotrauma

  https://kjnt.org/DOIx.php?id=10.13004/kjnt.2017.13.2.63

  Traumatic CSF leak is reported to be approximately 10% to 30% of the skull base fractures in adults. […] More than half of these CSF leak is presented within 48 hours of the trauma while almost all CSF leaks occur within 3 months in delayed manner. […] The most common fracture sites leading to CSF leaks following TBI are the frontal sinus (30.8%), sphenoid sinus (11.4-30.8%), ethmoid (15.4-19.1%), cribriform plate (7.7%), frontoethmoid (7.7%) and sphenoethmoid (7.7%). […] The early onset group includes the patients with CSF leak within 48 hours from trauma. […] In most cases of blunt injury, CSF rhinorrhea usually begins within 48 hours, and if it is not large, 60% to 70% is naturally blocked. […] However, in cases of large bone or dura defect, medical disease such as diabetes mellitus and situation of increased ICP, spontaneous healing of CSF leakage site had a high possibility of fail.

• #21 CSF Leaks in Hydrocephalus: Causes, Symptoms & Treatment

  https://www.hydroassoc.org/csf-leaks-in-hydrocephalus/

  Cerebrospinal fluid (CSF) cushions the brain, removes waste products, and delivers nutrients. For individuals with hydrocephalus, where the balance of CSF production and absorption is disrupted, the risk of complications like a CSF leak can be a significant concern. […] A CSF leak occurs when cerebrospinal fluid escapes through a tear or hole in the dura mater, the protective layer surrounding the brain and spinal cord. These leaks can happen spontaneously or as a result of trauma, surgery, or medical conditions. For individuals with hydrocephalus, the presence of a shunt system or other surgical interventions may increase the likelihood of a CSF leak. […] CSF shunts, which are commonly used to manage hydrocephalus, can occasionally lead to leaks if the tubing becomes dislodged, punctures the dura, or malfunctions.

• #22 CSF Leaks in Hydrocephalus: Causes, Symptoms & Treatment

  https://www.hydroassoc.org/csf-leaks-in-hydrocephalus/

  Surgical Interventions: Procedures like endoscopic third ventriculostomy (ETV) or shunt placement can sometimes create small tears in the dura. Spinal surgery can also result in tears to the dura. […] Overdrainage: Excessive drainage of CSF from a shunt can create pressure imbalances that act just like a CSF leak. […] Treatment for a CSF leak depends on the underlying cause and its severity. […] If the leak is due to overdrainage, adjusting the shunt’s settings or replacing it may resolve the issue. […] Rarely, it may be necessary for the doctor to externalize the shunt, allowing direct control and frequent adjustment of pressures, while the leak is being treated. […] Living with hydrocephalus can by itself be challenging. If there are concerns about a CSF leak then open communication with your medical team and vigilance about symptoms can significantly improve outcomes. Prompt diagnosis and treatment of a CSF leak are essential for avoiding further complications.

• #23 Causes of CSF Leak

  https://www.neurosurgeonsofnewjersey.com/blog/causes_of_csf_leak/

  However, often there is no apparent leak, rather the high pressure in the brain can displace brain tissue into the upper spinal canal (a type of Chiari 1 malformation) or other structures, then called encapholocele. […] They can also compress the veins in the brain causing venous congestion and venous stenosis. If you are diagnosed with any of those conditions, you may also have intracranial hypertension. […] Idiopathic intracranial hypertension (IIH), previously known as pseudotumor cerebri, has been recently renamed. While it is still not known why some people get long-term increases in brain pressure, this condition is not associated with a brain tumor.

• #24 Cerebrospinal Fluid (CSF) Leak | Choose the Right Test

  https://arupconsult.com/content/csf-leak-beta-2-transferrin

  Spontaneous cerebrospinal fluid (CSF) leaks have been reported in association with heritable connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome. CSF leaks are thought to occur because of the fragility of connective tissue in these disorders. […] Unlike cranial cerebrospinal fluid (CSF) leaks, which can often be confirmed with laboratory testing, spinal CSF leaks are diagnosed with imaging. In patients with chronic, unresolved symptoms suggestive of intracranial hypotension without another overt cause, magnetic resonance imaging (MRI) or digital subtraction myelography can be used to confirm the existence and location of a spinal CSF leak. […] Testing fluid from the ear or nose for -2 transferrin is the recommended method to assess patients for a cranial CSF leak because this approach is noninvasive as well as highly sensitive and specific.

• #25 Mechanism of chronic iatrogenic CSF leak following dural puncture-ventral dural leak: case report | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/early/2024/02/21/rapm-2023-105197

  Postdural puncture headache has been traditionally viewed as benign, self-limited, and highly responsive to epidural blood patching (EBP) when needed. […] However, the mechanisms accounting for the failure of EBP following dural puncture remain obscure. An understanding of these potential mechanisms is critical to guide management decisions in the face of severe and persistent cerebrospinal fluid (CSF) leak. […] A ventral rather than dorsal dural puncture is one mechanism that may contribute to both severe and persistent spinal CSF leak with resulting intracranial hypotension following a UDP. […] The different potential mechanisms contributing to a chronic CSF leak following UDP despite technically successful EBP, are incompletely described in the literature. […] In this case, lumbar MRI revealed a T2 hyperintense collection in the ventral epidural space anterior to the thecal sac rather than posterior to it, suggesting but not proving that the puncturing needle had traversed not only the dorsal dura, but crossed the thecal sac and punctured the ventral dura.

• #26 Mechanism of chronic iatrogenic CSF leak following dural puncture-ventral dural leak: case report | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/early/2024/02/21/rapm-2023-105197

  The risk of a ventral dural puncture leading to chronic leak symptoms has not gone completely unnoticed by experts in the field of CSF leak, and Schievink and Maya have reported on the occurrence of such ventral CSF leaks in a handful of patients with prolonged CSF leak following deliberate dural puncture in two separate reports. […] However, the occurrence of persistent ventral dural puncture following a UDP from an epidural has not been previously reported. […] The present case demonstrates the workup, management, and surgical intervention of a persistent ventral dural puncture as a previously undescribed mechanism of severe and persistent CSF leak after epidural anesthesia.

• #27 Cerebrospinal Fluid Leak | UCI Health | Orange County, CA

  https://www.ucihealth.org/medical-services/conditions/csf-leak

  Cerebrospinal fluid (CSF) is a colorless fluid that cushions the brain, protecting it from trauma and infections. Nasal CSF leaks are caused by small, sometimes microscopic breaks in the barrier between the brain and roof of the sinuses. […] Causes of CSF leak include head injuries and prior head or sinus surgery. […] Some leaks occur spontaneously without any trauma in patients with elevated intracranial pressure, termed idiopathic intracranial hypertension (IIH). […] The major risk of leaving a CSF leak unrepaired is a life-threatening infection of the lining of the brain called meningitis, which requires hospitalization and intravenous antibiotics to treat. […] A CT scan and/or MRI of the sinuses are often recommended to help identify the exact location of the defect responsible for the leak and assist with planning of the repair. […] A neurosurgeon is consulted at the time of surgery to assist with the insertion of a lumbar drain to decompress the CSF space. […] Once the leak is identified, it is repaired using the patients own tissue, which is usually obtained from the nose.

• #28 CME Activity | Cerebrospinal Fluid Leak | MDs & PAs

  https://www.statpearls.com/physician/cme/activity/1015/?deg=MD

  Cerebrospinal fluid (CSF) is a clear protein- and glucose-rich liquid in the subarachnoid space of the central nervous system. It is found in the ventricles, surrounding the brain, and within the central spinal column. CSF regulates central nervous system temperature, cushions the brain and spinal cord, and provides a delicately balanced buoyant force that allows the brain to retain its shape and circulatory integrity despite its weight and lack of intrinsic rigid support. A leak in this system, therefore, can be detrimental to brain blood supply and function and can increase the risk of direct trauma to brain parenchyma due to loss of fluid cushion. Additionally, the presence of a CSF leak indicates the need for further evaluation and management, as it may be due to a frontobasilar or temporal skull fracture. Open communication of the subarachnoid space with CSF leak presents a pathway for life-threatening CNS infection, including meningitis. This activity reviews the etiology, presentation, evaluation, and management of CSF leaks and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

• #29 Cerebrospinal Fluid Leaks – Diagnosis And Management — Physio Network

  https://www.physio-network.com/blog/cerebrospinal-fluid-leaks/

  The results of a recent study of CSF dynamics in patients with leaks led the authors to propose that some patients with spinal CSF leaks may develop scarring, fibrosis or adhesions between the meninges and surrounding tissues which could clearly have significant implications for the mechanical function of the spinal dura.

• #30 What is a CSF Leak? | CSF Leak Association

  https://csfleak.uk/resource/what-is-a-csf-leak

  Where a blood patch is not successful, a surgical sealant known as fibrin glue, or for more complex spinal or many cranial cases, neurosurgery, can be used to good effect if the site of the CSF leak is known. […] Where a leak continues, either through unsuccessful treatment or delayed diagnosis, long-term disability is not uncommon due to severe chronic pain, visual disturbance, seizures and nerve damage. […] CSF leaks were first documented in the 20th century by German neurologist Georg Schaltenbrand (1938) and later by American physician Henry Woltman of the Mayo Clinic (1950s). Despite the passing of time, CSF leaks are not fully understood, remain commonly misdiagnosed (particularly as migraine or sinusitis) and, as an area of clinical study, are significantly under-researched.

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