What causes cerebrospinal fluid (CSF) leaks?

Updated: May 08, 2020
  • Author: Kevin C Welch, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Cerebrospinal fluid (CSF) leaks are generally classified as traumatic, iatrogenic, and spontaneous/idiopathic. Traumatic causes include both blunt and penetrating facial injuries. Iatrogenic causes include neurosurgical and otolaryngologic approaches to neoplastic disease, as well as functional endoscopic sinus surgery (FESS). Most spontaneous, or primary, causes of CSF rhinorrhea are now thought actually to be secondary to elevations in intracranial pressure (ICP) that might be seen in patients with idiopathic intracranial hypertension (IIH). Congenital skull base defects and certain tumors can also lead to CSF rhinorrhea. [7]

A literature review by Lobo et al indicated that in addition to increased ICP, risk factors for spontaneous CSF leaks include obesity, female gender, and obstructive sleep apnea. In the study, about 72% of patients with spontaneous CSF leaks were female, and about 45% had obstructive sleep apnea. [8]

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