Cerebrospinal Fluid (CSF) Leak
Cerebrospinal fluid (CSF) leaks, also referred to as CSF fistulas, result from dura mater defects that allow CSF to escape from the intracranial space and into outer areas such as nasal and auricular cavities. The majority of CSF leaks result from traumatic injury, such as facial or skull fractures, but CSF leaks can also occur due to infection, hydrocephalus, congenital malformations, or neoplasms. They can be a complication of surgical procedures, especially those involving the ear, sinuses, or skull base, or can be spontaneous. The most severe consequences of a CSF leak are brain abscess or bacterial meningitis due to the passage of bacteria from nasal and paranasal areas into the intracranial space. Early diagnosis and intervention are critical to prevent these outcomes. Diagnosis can be challenging in outpatient and postsurgical contexts, in part because a CSF leak can be difficult to distinguish from chronic rhinitis. Beta (β)-2-transferrin testing is the preferred laboratory approach to assess patients for CSF leaks and can be especially helpful in these settings. Neuroimaging is used to confirm the diagnosis and to ascertain the location of the leakage.
Last Update: November 2019