The most common cause of cerebrospinal fluid (CSF) leaks is iatrogenic. However, the rare patient can develop increased pressure in the brain, resulting in erosion of the base of the skull and leakage of CSF through the nose or down the throat. These patients can present with positional headaches and MRI signs of low intracranial pressure.
Further diagnostic tests are typically necessary to identify the source of the leak, including CT Cisternography, Nuclear Medicine Cisternography, spinal imaging, cerebral angiography (blood vessel evaluation) and intra-operative fluorescent dye evaluation. If the etiology of increased intracranial pressure is identified (e.g. a venous blood clot), this should be treated and reversed.
Once the source of the leak is identified, various minimally invasive surgical procedures can be performed to seal the leak. These can be performed endoscopically through the nose or eyebrow in the majority of patients. In some patients, a ventriculoperitoneal or lumoperitoneal shunt may be necessary to augment the repair.