The University of Arizona
Department of Surgery

CSF Leaks

CSF rhinorrhea is leaking of the fluid that surrounds the brain into the nose.  This is a significant cause for concern, since the CSF fluid can become contaminated with bacteria in the nasal cavity and can result in meningitis. 

CSF leaks are often first detected because of dripping of a clear fluid from one side of the nose, especially when bending the head down. Dripping may be accompanied by headaches that are made better by lying down. CSF fluid may taste salty or metallic.

The most common causes of CSF rhinorrhea are trauma and previous sinus or brain surgery.  Spontaneous CSF leaks are often associated with a condition called Benign Intracranial Hypertension and can occur without a preceeding event.

Why Us? 
  • Dr. Alexander Chiu, Professor and Chief of The University of Arizona Division of Otolaryngology, is widely regarded as one of the country’s leading experts in the endoscopic repair of anterior skull base CSF leaks 
  • Dr. Chiu was part of the team that published the largest series to date of patients with spontaneous CSF leaks and was a thought leader on endoscopic repair of CSF leaks
  • Dr. Chiu is the only fellowship-trained rhinologist/skull base surgeon in Tucson and was previously the rhinology/skull base surgery fellowship director at the University of Pennsylvania in Philadelphia
  • The UA offers state-of-the-art medical & surgical care for patients with CSF leaks and employs the latest in surgical technology for the removal of associated lesions
  • The University of Arizona Center for Sinonasal and Skull Base Tumors, co-directed by Dr. Alexander Chiu and Dr. Michael Lemole, is one of the leading centers in the west coast for the treatment of CSF leaks; all CSF leaks are evaluated and treated by both neurosurgery and otolaryngology service, ensuring the best and most experienced opinions and results
  • Drs. Chiu and Lemole are conducting research trials into the repair of CSF leaks and are partnering with industry to investigate technology that results in better identification and repairs of CSF leaks
Treatment Options 

Accurate diagnosis of a CSF leak is critical to the correct treatment.  Tests of the fluid, such as a Beta 2 transferrin test, nasal endoscopy after intrathecal fluorescein injection and high resolution CT and MRI scans can help make the diagnosis. 

Once the diagnosis is made, surgical closure of the leak is the treatment of choice.  At the University of Arizona, nearly every case of CSF rhinorrhea is closed with endoscopic techniques, without the need for a cut on the face or a craniotomy. Published research indicates a 95 percent success rate for this approach vs. a 60 percent success rate when done via an open craniotomy. 

Patient Information