• Cerebrospinal fluid (CSF) leak may occur from the nose ( rhinorrhea ), from the external auditory canal ( otorrhea ), or from a traumatic or operative defect in the skull or spine. (medscape.com)
  • This leak of fluid can cause low-pressure headaches, neck pain, ringing in the ear, and, occasionally, loss of smell or taste. (medscape.com)
  • The most common locations of a CSF leak are the upper thoracic level (T1-T6) and the lower thoracic level (T7-T12). (medscape.com)
  • The fluid leak is a result of meningeal dural and arachnoid laceration with fistula formation. (medscape.com)
  • Traumatic CSF leak is reported in approximately 10-30% of skull base fractures in adults. (medscape.com)
  • This coronal magnetic resonance cisternogram demonstrates a left-sided cerebrospinal fluid leak through the cribriform plate (small arrows), which was clinically suspected. (medscape.com)
  • The image also shows a right-sided meningocele (large arrow) protruding through the cribriform plate, which was not suspected but was surgically repaired at the same time as the left cribriform cerebrospinal fluid leak site. (medscape.com)
  • Typically, the leak is caused by either spontaneous dural dehiscence or dural tears caused by degenerative causes. (medscape.com)
  • Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign: a central circle of blood and an outer clear ring of CSF. (medscape.com)
  • An absorptive sponge pad placed at or near the presumed site of fluid leak can facilitate the collection of the fluid. (medscape.com)
  • A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) surrounding the brain or spinal cord leaks out of one or more holes or tears in the dura mater. (wikipedia.org)
  • A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. (wikipedia.org)
  • A spinal CSF leak can be caused by one or more meningeal diverticula or CSF-venous fistulas not associated with an epidural leak. (wikipedia.org)
  • A CSF leak is classed as either non-spontaneous, caused by trauma including that arising from medical interventions, or spontaneous, sometimes in those with predisposing conditions (known as a spontaneous cerebrospinal fluid leak (sCSF leak). (wikipedia.org)
  • Any CSF leak is most often characterized by orthostatic headaches, which worsen when standing, and improve when lying down. (wikipedia.org)
  • The set of symptoms associated with a sCSF leak is referred to as a spontaneous cerebrospinal fluid leak syndrome (SCSFLS). (wikipedia.org)
  • Some people with a sCSF leak have a chronic leak of cerebrospinal fluid despite repeated patching attempts, leading to long-term disability due to pain and being unable to be upright, and surgery is often needed. (wikipedia.org)
  • Cranial leaks occur in the head, and in some of these cases, CSF can leak from the nose, or from the ear. (wikipedia.org)
  • Spontaneous intracranial hypotension, a subtype of CSF leak, refers to lower than normal than CSF volume due to an initially unknown or insidious cause. (wikipedia.org)
  • This differentiates it from CSF leaks of known causes such as cranial or spinal trauma, surgery or lumbar puncture or spinal anesthesia (most common cause of CSF leak). (wikipedia.org)
  • The most common symptom of a CSF leak is a fast-onset, extremely painful orthostatic headache or thunderclap headache. (wikipedia.org)
  • This may be an initial presentation of a spontaneous CSF leak or appear after treatment such as an epidural patch, and likely indicates a slow CSF leak. (wikipedia.org)
  • While high CSF pressure can make lying down unbearable, low CSF pressure due to a leak can be relieved by lying flat on the back. (wikipedia.org)
  • Extracted data includes patient demographics, tumor pathology, surgical approach, and postoperative outcomes including incidence of cerebrospinal fluid (CSF) leak and other postoperative complications, length of stay (LOS), and readmission and reoperation rates. (bvsalud.org)
  • Four studies found a significant increase in postoperative CSF leak in obese patients compared to nonobese controls. (bvsalud.org)
  • Cisternography with an intrathecal injection of radioisotope or nonionic iodinated myelographic contrast medium or magnetic resonance imaging (MRI) cisternography usually localizes the CSF leak. (medscape.com)
  • [ 1 ] CSF leaks occur when there is a tear or hole in the dura mater, which is the outermost layer of the meninges that protects the central nervous system. (medscape.com)
  • According to Ommaya et al, 80% of CSF leaks are due to nonsurgical trauma, 16% are iatrogenic, and 4% are spontaneous. (medscape.com)
  • Spontaneous spinal CSF leaks are associated with heritable connective tissue disorders including Marfan syndrome and Ehlers-Danlos syndromes. (wikipedia.org)
  • Cerebrospinal fluid leaks are classified into two main types: cranial leaks, and spinal leaks. (wikipedia.org)
  • Both cranial and spinal CSF leaks cause neurological symptoms as well as spontaneous intracranial hypotension, diminished volume, and pressure of the cranium. (wikipedia.org)
  • Nine studies evaluated the relationship between obesity and CSF leaks. (bvsalud.org)
  • The enzyme B2Tr is produced in the brain by neuraminidase activity and is present in CSF, perilymph, and ocular aqueous humor but not in sinonasal mucous secretions and tears. (medscape.com)
  • It is produced in epithelial cells of the choroid plexus and meninges and is found in CSF, perilymph, seminal fluid, and urine. (medscape.com)
  • CT cisternography or radionuclide cisternography may be useful if CT and MR cisternography do not show the CSF fistula. (medscape.com)
  • Radionuclide cisternography may be useful to detect an intermittently active CSF fistula. (medscape.com)
  • On occasion, the methods listed above do not localize the CSF fistula, and surgical exploration may be necessary. (medscape.com)
  • All methods of cisternography-radionuclide, CT, and MR-provide improved or optimal CSF fistula detection when the fistula is active and when a Valsalva maneuver or jugular venous compression is added to the imaging protocol. (medscape.com)
  • Coronal CT image of the temporal bone demonstrates a bone defect (small arrows) in the tegmen tympani with a protruding soft-tissue meningoencephalocele (large arrows). (medscape.com)
  • Coronal fast spin-echo T2-weighted image demonstrates herniation of meninges and brain tissue (arrows) with adjacent cerebrospinal fluid into the postmastoidectomy tegmen tympani defect. (medscape.com)
  • PURPOSE: Cerebrospinal fluid (CSF) leakage is a frequent complication after spinal surgery. (bvsalud.org)
  • LDP was performed on patients with suspected CSF leakage due to a dural tear during spinal surgery or in whom mixed-color CSF was observed in the hemo-drain after surgery. (bvsalud.org)
  • In conclusion, LDP is a safe and effective treatment for CSF leakage after spinal surgery. (bvsalud.org)
  • Confirm or exclude the presence of CSF in leaking fluid by means of an immunoelectrophoretic study of the fluid for beta-2 transferrin (B2Tr) or, where available, beta-trace protein. (medscape.com)
  • Immunoelectrophoretic assay of beta-trace protein has been reported to have high specificity and sensitivity for CSF detection. (medscape.com)
  • the frontal and temporal lobes are particularly vulnerable to this type of injury. (msdmanuals.com)
  • Further, the headache must have a temporal relation to the low CSF pressure or leakage and the headache cannot be better explained by another ICHD diagnosis. (wikipedia.org)
  • The hemo-drain was opened to confirm that CSF was no longer mixed or oozing, at which time the lumbar drain was removed. (bvsalud.org)
  • Of those 21 patients, improper insertion due to a technical problem occurred in 15 patients, poor line fixation occurred in 2 patients, and CSF leakage was again observed after removal of the lumbar drain in 4 patients. (bvsalud.org)
  • Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. (medscape.com)
  • [ 15 ] For this specialized laboratory study, 0.5-1.0 mL of the fluid may be required. (medscape.com)
  • Lateral 24-hour cranial scintigraphic image from a nuclear medicine cisternographic study in a patient with clinically evident right-sided cerebrospinal fluid rhinorrhea. (medscape.com)
  • This patient had cerebrospinal fluid otorrhea after mastoidectomy. (medscape.com)
  • Among the 122 patients, 1 patient was discharged with left hemiparesis due to cerebral venous infarction (CVI) and hemorrhage after LDP, and 1 patient underwent re-operation because the CSF collection was not resolved. (bvsalud.org)
  • Serum glucose, chloride, and total protein tests of the fluid are not specific or conclusive for CSF. (medscape.com)
  • This feature is the basis for a specific test for CSF based on immunoelectrophoresis. (medscape.com)
  • Among the 122 patients, the CSF leakage in 101 patients was resolved with the initial procedure, but 21 patients required re-insertion. (bvsalud.org)
  • [ 2 ] Include all of the paranasal sinuses and petrous temporal bones in the scans. (medscape.com)
  • It is approximately 35 times more concentrated in CSF than in blood serum. (medscape.com)
  • The International Classification of Headache Disorders (ICHD) Third Edition diagnostic criteria for spontaneous intracranial hypotension includes any headache attributed to low CSF pressure (low CSF opening pressure) or CSF leakage (evidence of CSF leakage on imaging). (wikipedia.org)
  • A loss of CSF greater than its rate of production leads to a decreased volume inside the skull known as intracranial hypotension. (wikipedia.org)
  • While this symptom can be referred to as intracranial hypotension, the intracranial pressure may be normal, with the underlying issue instead being low CSF volume. (wikipedia.org)
  • The International Classification of Headache Disorders (ICHD) Third Edition diagnostic criteria for spontaneous intracranial hypotension includes any headache attributed to low CSF pressure (low CSF opening pressure) or CSF leakage (evidence of CSF leakage on imaging). (wikipedia.org)
  • The final criteria is that in the rare cases of spontaneous intracranial hypotension with no headache present, the neurologic symptoms that are present must be attributable to low CSF or explained by the diagnosis of spontaneous intracranial hypotension. (wikipedia.org)
  • 5 , 6 Patients may present with symptomatic unilateral conductive hearing loss, middle ear fluid, otorrhea, rhinorrhea (from CSF flow through the Eustachian tube), or facial nerve paresis. (ajnr.org)
  • 3. Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone. (nih.gov)
  • Gacek RR, Leipzig B. Congenital cerebrospinal otorrhea. (medscape.com)
  • 18. Fallopian Canal Meningocele with Spontaneous Cerebrospinal Fluid Otorrhea: Case Report and Systematic Review of the Literature. (nih.gov)
  • Observation of fluid or a meningocele within the facial nerve canal is a potential source of consternation to radiologists. (ajnr.org)
  • 19. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. (nih.gov)
  • Stevens SM, Hock K, Samy RN, Pensak ML. Are Patients with Spontaneous CSF Otorrhea and Superior Canal Dehiscence Congenitally Predisposed to Their Disorders? (medscape.com)
  • Management of complications from 820 temporal bone fractures. (medscape.com)
  • In the adult population, approximately 90% of temporal bone fractures are associated with concurrent intracranial injuries and 9% with cervical spine injuries. (medscape.com)
  • This is also why a thorough understanding of the etiology, classification, complications, and treatment of temporal bone fractures is mandatory for healthcare professionals involved in the care of individuals with such injuries. (medscape.com)
  • Contemporary CT imaging will be able to identify temporal bone fractures, including the type and direction, as well as the presence or absence of otic capsular involvement and the involved segment of temporal bone. (medscape.com)
  • Further, the headache must have a temporal relation to the low CSF pressure or leakage and the headache cannot be better explained by another ICHD diagnosis. (wikipedia.org)
  • the existing literature has focused on either microscopic analyses or meningoceles with bony dehiscence leading to symptomatic CSF leakage. (ajnr.org)
  • 6. Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects--case series and review of the literature. (nih.gov)
  • The clinical presentations specifically related to temporal bone trauma include facial nerve paralysis (partial or complete), hearing loss (conductive, sensorineural, or mixed), vertigo , dizziness , otorrhagia, cerebrospinal fluid (CSF) otorrhea , tympanic membrane perforation , and hemotympanum and canal laceration. (medscape.com)
  • Facial nerve canals were assessed for the presence of fluid along each segment and meningoceles within either the labyrinthine segment (fluid-filled distention, ≥1.0-mm diameter) or geniculate ganglion fossa (fluid-filled distention, ≥2.0-mm diameter). (ajnr.org)
  • Of 204 patients, 36 (17.6%) had fluid in the labyrinthine segment of the facial nerve canal and 40 (19.6%) had fluid in the geniculate ganglion fossa. (ajnr.org)
  • Uncomplicated, minuscule amounts of CSF leakage may only cause discomfort and not require surgical intervention. (medscape.com)
  • Methods: The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. (bvsalud.org)
  • Objective:To discuss the application of two surgical methods, trans-mastoid approach and trans-canal endoscopic approach, in the treatment of CerebroSpinal Fluidï¼ CSFï¼ otorhinorrhea due to inner ear malformationï¼ IEMï¼ in children. (bvsalud.org)
  • Methods:Children with CSF otorhinorrhea due to IEM, from July 2015 to Jan 2021, in ENT department, Beijing Children's Hospital were retrospectively analyzed, and the clinical data, surgical methods, complications, recurrence and follow-up were recorded. (bvsalud.org)
  • A retrospective review was completed of patients with high-resolution MR imaging of the temporal bone whose clinical presentations were unrelated to facial nerve pathology. (ajnr.org)
  • most patients with temporal bone fracture have a computed tomography (CT) scan of these. (medscape.com)
  • No significant difference was observed in the ages of patients with fluid in the labyrinthine segment of the canal or geniculate ganglion compared with those without fluid ( P = .177 and P = .896, respectively). (ajnr.org)
  • 1 If otorrhea is present, preoperative meningitis has been reported in approximately half of patients. (ajnr.org)
  • The spectrum of temporal bone trauma is extremely varied, ranging from minor concussion without functional deficits to severe blunt or penetrating trauma with multifunctional deficits that involve the auditory and vestibular nerves, the facial nerve, and the intracranial contents. (medscape.com)
  • Half of them had a history of otorhinorrhea, and 53.3% of them were diagnosed as cerebrospinal fluidï¼ CSFï¼ otorrhea at the first onset Unilateral and bilateral IEM were 22 cases and 8 cases respectively. (bvsalud.org)
  • 96.7% CSF otorhinorrhea were unilateral, there was no relationship between CSF otorhinorrhea and the malformation side or the time of CI surgery. (bvsalud.org)
  • The increased CSF pressure causes infiltration of the sella with CSF and displacement of the pituitary tissue. (medscape.com)
  • 7. Skull base surgery for removal of temporal bone tumors. (nih.gov)
  • Therefore, fractures that involve the temporal bone continue along the skull base with a pattern that follows the weakest points of the anatomy. (medscape.com)
  • Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery. (bvsalud.org)
  • Except one case lost, the others were followed up for 1.2-6.7 years, and no recurrence of pneumonia, meningitis and CSF otorhinorrhea happened. (bvsalud.org)
  • Such findings should be considered of little clinical importance without radiologic evidence of CSF otorrhea, meningitis, or facial nerve palsy. (ajnr.org)
  • Fluid within the labyrinthine and geniculate segments of the facial nerve canal is relatively common. (ajnr.org)
  • Testing the fluid for glucose level helps to distinguish spinal fluid from nasal secretions, which are low in glucose. (medscape.com)
  • Localization of an otogenic spinal fluid leakage is usually accomplished using imaging studies. (medscape.com)
  • Spinal fluid, bright on T2 sequences, may be observed entering the middle ear. (medscape.com)
  • Results: In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. (bvsalud.org)
  • However, the initial assessment of the temporal bone trauma in the emergency department by the emergency personnel and the trauma team is critically important. (medscape.com)
  • Unless the source is obvious, such as in a case of recent surgery or trauma, attempt to document that the draining fluid is in fact CSF. (medscape.com)
  • Temporal bone fracture is a frequent manifestation of head trauma. (medscape.com)
  • Most cases of temporal bone fracture involve severe body and/or head trauma. (medscape.com)
  • [ 2 ] Therefore, management of the temporal bone trauma may not be the first priority. (medscape.com)
  • During the follow-up period, the authors found no evidence of wound infections, neurovascular damage, or CSF leakage requiring reoperation. (medscape.com)
  • The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. (bvsalud.org)
  • Intrathecal gadolinium-enhanced MR cisternography in the evaluation of CSF leakage. (medscape.com)
  • Objective: To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. (bvsalud.org)
  • Results:30 children with CSF otorhinorrhea due to IEM were included. (bvsalud.org)
  • Testing for beta2 transferrin, a substance found only in CSF, may identify the true nature of the substance with a greater degree of certainty. (medscape.com)
  • The temporal bone is a very thick and hard structure located in the base of the skull. (medscape.com)
  • the frontal and temporal lobes are particularly vulnerable to this type of injury. (msdmanuals.com)