Treatment for a CSF leak depends on the type and location of any hole or tear, as well as the underlying cause.
Some common treatments for a CSF leak include:
- Bed rest
- Hydration (2-3 litres per day)
- IV Caffeine infusions
- Strong coffee or caffeine tablets
An epidural blood patch, where blood is drawn from the patient and immediately injected into the epidural space, is the most common invasive treatment for spinal leaks. Where the leak site is known, blood will be injected as close to it as possible. Where the leak site is not known, a high volume blood patch (typically 20ml) is injected into the lumbar spine (less commonly, the thoracic spine). Blood patches are generally thought to be relatively safe, but occasional reports of increased CSF pressure, persistent epidural fluid collections, nerve damage and infection have been reported.
Fibrin glue can be applied in much the same way as a blood patch to seal a known spinal CSF leak site. Fibrin glue is often used where a blood patch repeatedly fails. Occasionally, glue may be mixed with blood and injected as a combination patch, and this is sometimes used where the precise leak site is not known, but a relatively small area of the spine is suspected.
A surgical repair may be performed where a patient fails to respond to a blood patch or a blood patch fails, if the site of the leak has been identified. Surgical repairs can include suturing, the application of artificial dura patches and the use of aneurism clips. If the site is not known, but an area is suspect, exploratory surgery may sometimes be possible, with any discovered leak being repaired as above. Cranial leaks tend to require surgery as there a few less invasive treatment options.