Cerebrospinal fluid fistula

Last edit by Alaric Steinmetz on

Synonyms: Liquorleck, CSF fistula

A cerebrospinal fluid fistula, also known as a CSF leak, refers to a breach in the cerebrospinal fluid system that communicates with an external space, thus allowing cerebrospinal fluid to escape. CSF fistulas typically lead to orthostatic headaches due to the reduced volume of cerebrospinal fluid. The causes of a CSF fistula vary.

Postoperative CSF Fistula

CSF fistulas can occur after surgical intervention in the area of the spine or the head, when after opening the dura mater, it cannot be sealed watertight.

Postoperative lumbar cerebrospinal fluid fistula
Postoperative lumbar cerebrospinal fluid fistula in a sagittal and axial T2 sequence in MRI.
Spinal CSF leak in an MR myelography
Visualization of a postoperative spinal CSF leak in an MR myelography.

Spontaneous CSF Fistula

CSF fistulas, particularly in the area of the spine, can also occur spontaneously due to a dural defect without surgical intervention[^1]. This can lead to the clinical picture of spontaneous intracranial hypotension.

Traumatic CSF Fistula

CSF fistulas occur in 2-3% of all patients with a cranial trauma, with approximately 60% of these CSF fistulas occurring on the first day of trauma and 95% within the first 3 months post-trauma[^3].

Infection Risk

The incidence of meningitis due to a CSF fistula is about 5-10%, with increased risk if the CSF leak persists for more than 7 days[^2]. Approximately 83% of these cases result in pneumococcal meningitis[^2].