The Spinal Fluid which is also referred to as Cerebrospinal Fluid or CSF is a fluid that surrounds the brain. The primary function of spinal fluid is to act as a shock absorber for the brain and the central nervous system and prevent the brain from any injury. The Spinal Fluid also circulates nutrients from the blood in the brain and allows is to function normally.
The Spinal Fluid is normally in a solitary area in the skull and goes down the spine but at times due to some unexpected injury to the head or due to some other causes the bone which prevents the spinal fluid from seeping from the brain cavity into the nasal cavity gets damaged resulting in the Spinal Fluid entering the nasal cavity. This is what is termed as a Spinal Fluid Leak.
An individual with a Spinal fluid leak will complain of persistent headaches and constant nasal drainage usually from one nose. The drainage from the nose increases whenever the individual does any strenuous activity like bending over to pick something up. A spinal fluid leak can be easily diagnosed with advanced imaging in the form of a CT or an MRI scan of the brain and sinuses.
How is Spinal Fluid Leak Fixed?
A spinal fluid leak as a result of a head injury or trauma is fixed conservatively by placement of a lumbar drain placed in the back which drains out the spinal fluid in small amounts. This results in decreasing any pressure that may have been caused due to the injury resulting in Spinal Fluid Leak. Post placement of the drain, the patient is advised complete bedrest and is also abstained from any strenuous activity to allow the condition to heal by itself.
In cases where a cause for CSF Leak cannot be established then surgery is required to fix the spinal fluid leak. The surgery can be done through two approaches of which one is through the brain and the other is through the sinuses. The latter is the most preferred form of surgery to fix the Spinal Fluid Leak as it has fewer risks and the outcome is also more favorable than the approach through the brain.
The surgical approach to fix the spinal fluid leak through the brain requires an incision to be made through the skull and pulling the brain slightly away from the skull base in order to identify the defect, and once identified, fix the defect. Such a procedure requires a neurosurgeon and is done under general anesthesia. However, the failure rate of this procedure to fix spinal fluid leak is estimated to be close to about 30%. This is precisely the reason why this surgical approach for fixing spinal fluid leak is no longer preferred.
The much preferred sinus approach towards fixing spinal fluid leak requires preoperative images to identify the exact location of the defect. Once the location of the defect is identified, the sinuses are opened under direct visualization through an endoscope and the mucosa is removed to allow clear visualization of the defect. In case if the defect is small then only one layer of support over the defect is sufficient to fix the spinal fluid leak. In case if the defect is large then the surgeon may place a layer of support between the brain and the body side of the defect, along with another layer as support in the sinus side of the defect.
Once a complete fix of the defect is confirmed and the surgeon is sure that there is no more spinal fluid leak then more packing is placed to permanently close the defect and fix spinal fluid leak. The patient is then sent to the postoperative unit where the individual is observed for at least a period of 24 hours and is then discharged. It normally takes around 4-6 weeks for an individual to completely recover from surgery to fix spinal fluid leak.