Spinal Fluid Leak (CSF Rhinorrhea) & Encephalocele Repair
A CSF leak occurs when the membrane containing spinal fluid tears, allowing clear fluid to drain from the nose or ear. Leaks can follow head injury, sinus surgery, or arise spontaneously — often in patients with elevated intracranial pressure. An encephalocele is a small herniation of brain lining through a defect in the skull base. Untreated leaks carry a risk of meningitis, so repair is recommended.
Most leaks are repaired endoscopically through the nose with ENT colleagues, using the patient’s own tissue to seal the defect. Underlying pressure issues are addressed to prevent recurrence.
Symptoms
- Clear, watery drainage from one nostril, worse when bending forward
- Salty or metallic taste
- Positional headaches
- Recurrent meningitis
How it is diagnosed
Beta-2 transferrin test of the fluid, high-resolution CT of the skull base, MRI, and sometimes CT cisternography.
Treatment options
Without surgery
Bed rest and lumbar drain for some traumatic leaks; pressure-lowering strategies.
Surgical options Dr. Daggubati offers
- Endoscopic endonasal CSF leak / encephalocele repair
- VP shunt for elevated intracranial pressure when needed
Common questions
How do I know if the fluid from my nose is spinal fluid?
Spinal fluid is clear, watery, often one-sided, and tends to drip when you lean forward. A simple laboratory test (beta-2 transferrin) on a sample of the fluid confirms it. Persistent clear drainage after a head injury or sinus surgery should always be checked.
Why do leaks happen without any injury?
Spontaneous leaks are usually related to raised pressure inside the head, often in people who are overweight, which slowly wears a hole through the thin bone of the skull base. That is why treating the pressure is part of the repair.
What is the success rate of repair?
Endoscopic repair seals the leak in over 90% of cases on the first attempt; the remaining cases are usually closed with a second procedure or by treating the underlying pressure.
Not sure this is you?
Bring your imaging and your story. A single visit usually clarifies what is going on and which options are realistic. Request an appointment or call (301) 718-9611.