Mayo Clinic neurologist Jeremy K. Cutsforth-Gregory, M.D., discusses the different types of cerebral spinal fluid (CSF) leaks and the treatment options at Mayo Clinic. All patients see a collaborative care team and follow an individualized treatment plan that is developed using high-quality imaging and advanced technology.
talk about a couple of different types of CSF leaks today, but all of them I think are under recognized. We're doing our best to educate both patients and providers on how to recognize it because whether that means someone can get treatment locally or be referred here and we want to help because this is usually a treatable reversible condition. Probably the most important kind of breakdown that we make right off the bat, which is leaks that come either out the nose or the ear, what we call skull based leaks and leaks that occur along the spine because the symptoms are different. The treatments are different. First, with school based leaks. Its patients with high pressure inside the head. That can happen in young women who are overweight would be the most common and the symptoms of a high pressure headache worse at night. You wake up with a headache in the morning and you get leakage, you can lean forward and drip drip drip out. It comes the spinal lead patients. About 85% of patients will have an Ortho static headache when it gets worse when they stand up, better when they lie down and then the rest of the patients have other things like dizziness, ringing in the ears, sometimes double vision or changes in vision. There's even a type of dementia that can be caused by when the brain sags down. So much. So it's a wide range of things and I think that's probably why the diagnosis doesn't always come to people's mind, the most common risk factor for the spinal CSF leak is joint hypermobility. So maybe this patient actually has connective tissue disease, like more fans or Ehlers Danlos, but often they just have a degree of kind of double jointed nous because that can be a risk factor that maybe their connective tissues are looser more prone to leaking. So that initial evaluation, you know, I can get a story um by telehealth quite well and save the patient the trip and kind of outline. Okay, so which tests are likely going to need and get them pre scheduled. Once I have a clinical suspicion, then they go for imaging. The first test really is M. R. I. Scan of the brain because it'll show changes either the brain sagging down from where it belongs or that meninges the outer layer getting thicker and taking up the contrast dye more than normal. They have to come here to get the high quality imaging and to get the treatments. But if we can start and end telehealth, I think it's saving a lot of people some time and convenience. There Now recognized three big types. So the first one to be a bone spur that cuts through the dura or the meninges and causes a leak. A Type two leak is a tear in the nerve root sleeve and then the most recent and this is the one where we've made a lot of advances recently. It's called a fistula type one and type two and blood patches. So it's putting a needle near the dura and injecting the patient's on blood to try to kind of clot it off, cover the whole let it form a scar. And that works for the type one. Sometimes definitely works with the type two leaks. But the fistula that blood actually can't get into that internal hole. So that will do a catheter through the groin, snake it up into the spine and then glue the vein shot from inside. It's a minimally invasive and very effective treatment that in the past we would have had to have done a spine surgery to to cut open the spine and correct. But now we can do it through a catheter based process. What it takes is a multidisciplinary team and I think that's why Mayo clinic is able to do this. So I'm a neurologist and maybe are kind of the frontline assessing these patients. But I couldn't do it without anesthesiologist to do blood patches, radiologist to do and interpret the scans that are sometimes quite subtle and occasionally a surgeon to fix when we can't do it other ways. So it's a multidisciplinary effort. It's a great privilege to be part of that team. And and here's a place we can do it Well