A cerebrospinal fluid (CSF) leak occurs when the membrane surrounding the brain (dura) is torn, allowing CSF to drain into the nasal cavity. This presents as a clear, watery nasal discharge — often worse on bending forward.
Causes
- Skull base fractures (following head trauma)
- Spontaneous CSF leaks (in raised intracranial pressure)
- Following sinus or skull base surgery
- Tumour eroding the skull base
Why CSF Leaks Require Treatment
Untreated CSF leaks carry a significant risk of meningitis. Persistent leaks also require surgical repair to prevent recurrent infection.
Diagnosis
- Beta-2 transferrin test on nasal fluid (confirms CSF)
- High-resolution CT scan of the skull base
- MRI cisternography to localise the defect
Endoscopic Repair
Most CSF leaks can be repaired endoscopically through the nose, without any craniotomy. Prof Lubbe uses a layered closure technique using the patient’s own tissue (mucosal flap, fat, and cartilage) to seal the defect. Success rates exceed 90%.