Frequently Asked Questions
What is a cerebrospinal fluid (CSF) leak?
The brain and the spinal cord are surrounded by a fluid called cerebrospinal fluid (CSF), which is in a sac-like covering called the meninges. The thickest outer layer of the meninges is the dura. The brain normally floats in this fluid, which helps to cushion the brain from injury. A CSF leak happens when a tear or hole in the dura allows the fluid to leak out. When a CSF leak occurs, it reduces the fluid volume and pressure drops, a condition known as intracranial hypotension. When this occurs, the brain can sag, causing a headache that worsens when the body is in an upright position. CSF leak is the most common known cause of intracranial hypotension.
What causes CSF leak?
CSF leak can occur following medical procedures such as a lumbar puncture (spinal tap), epidural injections or spine surgery. In these situations, the condition usually is found quickly.
In other cases, the condition may occur spontaneously, usually due to an underlying weakness of the dura. CSF leaks often are the result of connective tissue disorders, which can cause this weakened dura.
How common are CSF leaks?
Since many patients with this condition never seek medical care, or their symptoms go away without treatment, the prevalence of cerebrospinal fluid leaks is unknown. An emergency department study at Cedars-Sinai estimated that new spontaneous cases occur each year in at least 5 per 100,000 people. However, this sort of study tends to underestimate how often these cases occur, because it includes only a more severely affected group of patients.
Cerebrospinal fluid leaks may occur at any age, but is more common among people between the ages of 30 and 60, with most cases happening around 40 years old. CSF leaks occur more often in women than in men.
How are CSF leaks treated?
For many patients, symptoms go away without any specific treatment. Bed rest, increased hydration and caffeine intake are usually the initial course of treatment. An abdominal binder also may reduce headache pain by increasing fluid pressure in the head.
When these conservative measures don't work, the most common treatment is epidural blood patching, which may be done even when the specific location of the leak is unknown. In this procedure, some of the patient's blood is injected into the spinal canal outside the dura. The blood clots over the hole, stopping the leak. This may be performed several times.
Other options include epidural injections of fibrin glue or surgery at the precise location of the leak. Surgical interventions use sutures, clips, synthetic sealants or artificial materials to close the tear.
What sets Cedars-Sinai's CSF Leak Program apart?
The CSF Leak Program is led by world-renowned neurosurgeon Wouter I. Schievink, MD, who also serves as director of microvascular neurosurgery at Cedars-Sinai. Schievink’s expertise in intracranial hypotension and CSF leak has led to the development of highly specialized diagnostic, treatment and surgical options for patients.
How can I be become a patient at the CSF Leak Program?
Depending on your healthcare insurance, you may need a referral from your primary care physician before making an appointment. Please call 1-800-CEDARS-1 (1-800-233-2771) or e-mail firstname.lastname@example.org for more information.
For information on reaching us from outside the United States, please contact our International Health Services team.
I already have a diagnosis. Can I get a second opinion at Cedars-Sinai?
Yes. To get a second opinion with a Cedars-Sinai physician, please call 1-800-CEDARS-1 (1-800-233-2771) or email email@example.com.
How should I prepare for my appointment?
It is important for patients to be prepared for their appointment in order to ensure the time spent with the physician is as beneficial as possible.
Here’s what you can do to make the most of your appointment time:
- Write down and bring any questions you have about your condition or treatment.
- Keep a record of your symptoms, including any changes you may have noticed between appointments and whether the symptoms are affecting your work or personal life.
- Bring all medications, supplements and vitamins you are currently using.
- Bring your prior medical records if you’re transferring from a medical provider outside the Cedars-Sinai network.
- If possible, fill out any required paperwork in advance, including medical record release authorization, referral request, patient intake and patient privacy forms.
Should I bring someone with me?
Yes, patients are encouraged to bring a spouse, family member or close friend with them to their appointments.
How can I find out more about ongoing clinical trials and whether I can participate?
Neuroscience experts at Cedars-Sinai are using their clinical experience and research knowledge to lead the way to new treatments, techniques and diagnostic procedures.
Our ongoing clinical trials are open to all eligible participants, and patients are encouraged to pursue involvement.
General information about participation in clinical trials at Cedars-Sinai can be found in our Patient and Visitors Guide.
Publications by our expert neurosciences team can be found at PubMed.gov.
Where can I learn more about Cedars-Sinai?
For more than a century, Cedars-Sinai has been dedicated to excellence, compassion and innovation in patient care. Information about Cedars-Sinai and our history can be found in the About Us section of the website.