CRANIAL SURGERY

Cerebrospinal Fluid Leak Repair

Cerebrospinal Fluid Leak Repair

PROCEDURE

What is Cerebrospinal fluid leak repair?

Cerebrospinal fluid (CSF) is a clear fluid that surrounds the brain and spinal cord and is essential to how they function by cushioning and protecting them. CSF leaks can cause severe symptoms that make it challenging or even impossible to go about your life as usual, but this condition is usually very treatable.

Often patients with a CSF leak will simply have symptoms of clear fluid running from one nostril only. Other associated symptoms include headaches and visual changes.

CSF leakage through the nose can occur spontaneously, with no discernible cause. However, common causes include:

  • Head or spine trauma
  • Complication of endoscopic sinus surgery
  • Abnormally high CSF volume (hydrocephalus)
  • Untreated intracranial hypertension
  • Brain tumours
  • Skull defects present from birth
  • Certain connective tissue disorders

To diagnose a CSF leak, Mr Annakan Navaratnam will assess symptoms, medical history, and perform a physical examination. If there is a clinical concern for a CSF leak he will organise investigations to test  fluid from the nose and imaging such as CT or MRI scans to identify the cause and location of the CSF leak.

If a patient has the presence of an ongoing CSF leak, it is essential for this to be repaired to prevent infection spreading into the surrounding structures in the brain (meningitis).

CSF leaks causing fluid to leak from the nose can be repaired through endoscopic nasal surgery therefore avoiding the need for external incisions to the face or head.

Endoscopic sinus surgery

At a glance

Surgery time

1 – 2 hours

Anaesthetic

General

Time off work

4 weeks

Hospital stay

Overnight stay (usually 2 nights)

Shower

After 2 days

Reasonable mobility

Bedrest for 2 days, limited mobility for 1 week

Exercise

After 6 weeks

Sleeping on back

4 weeks

Full recovery

6 – 8 weeks

Driving

2 weeks

ENT SPECIALIST

Mr Annakan Navaratnam

Annakan Navaratnam is Consultant Ear, Nose & Throat (ENT) Surgeon whose private practice is based at Harrow and One Welbeck Hospital in Central London and The Clementine Churchill Hospital in Harrow. In his NHS practice, he works at Royal National ENT Hospital, University College London Hospital (UCLH) and is an honorary consultant at Great Ormond Street Hospital.

He has a subspeciality interest in rhinology and facial plastic surgery with particular expertise in septorhinoplasty and nose reshaping surgery.

Annakan is excellently placed to manage general adult and paediatric ENT presentations and in particular is able to assess and treat complex problems related to the form and function of the nose. This includes endonasal (scarless) rhinoplasty, revision septorhinoplasty as well as advanced endoscopic sinus surgery.

What to expect

Here you will find some essential information to help you prepare for surgery and the arrangements you should make to ensure you have the support you need and that everything runs smoothly on the day. However, we are on hand to answer any questions you may have.

The first stage is always a comprehensive consultation and pre-operative assessment with your surgeon Mr Annakan Navaratnam.

whether surgery is appropriate at this time. The potential risks, post-surgery expectations, and recovery details of the specific procedure will also be discussed. A detailed medical history will be obtained to ensure your fitness for surgery.

During the consultation, Mr Annakan Navaratnam will assess symptoms, medical history, and perform a physical examination. If there is a clinical concern for a CSF leak he will organise investigations to test any fluids from the nose and imaging such as CT or MRI scans to identify the cause and location of the CSF leak.

A two-week reflection period follows the initial consultation, during which you can return for additional consultations free of charge.

If you decide to proceed, you’ll receive guidance on preparing for surgery. Pre-surgery tests may be required.

Mr Navaratnam will advise you on stopping smoking as far in advance of surgery as possible due to its impact on healing, infection risks, and complications during anaesthesia. Guidance on discontinuing blood-thinning medication and fasting before surgery will be provided.

Upon arrival at hospital, you’ll be escorted to a private room, and vital signs will be assessed. Your surgeon will finalise markings, and the anaesthetist will visit you. Clinical photography will document the pre-op and post-op phases.

The procedure is typically performed under general anaesthesia, followed by recovery in a specialist recovery room. Surgery can be performed as a day case so once you have recovered sufficiently you will be discharged into the care of a friend or family member.

Post-surgery pain varies for each individual, but most patients find it minimal and can be managed with over-the-counter painkillers. It typically subsides within the first week or so along with any bruising.

A comprehensive recovery guide, including follow-up appointment dates. Our team will be on hand if you have any concerns.

Frequently asked questions

CSF leaks can present with various symptoms, including:

  • Headaches
  • Persistent fluid running from one nostril
  • Meningitis
  • Tinnitus
  • Balance issues
  • Vision changes (blurred vision, double vision)
  • Sensitivity to light and sound
  • Neck stiffness and pain
  • Nausea and vomiting
  • Pain in the arm and upper back

Although generally rare, non-trauma related CSF leaks are more common over the age of 30 and more likely to affect women. It can cause intracranial hypotension, which is a very rare condition, but it likely that CSF leaks are more common than this as they can be misdiagnosed as another condition such as migraine or sinusitis.

CSF leaks causing fluid to leak from the nose can be repaired through endoscopic nasal surgery therefore avoiding the need for external incisions to the face or head. Tissue from within the nose or from the beneath the skin of the thigh can be use to repair CSF leaks.