CSF Leak Treatment from ENT Clinic in Boise, Idaho

An ENT doctor (also called an ear, nose, and throat doctor) is the type of medical specialist who, among treating many other ear, nose, and throat conditions, helps diagnose, assess, and treat cerebrospinal fluid (CSF) leaks.

At Treasure Valley Nasal and Sinus Center in Boise, ID, founder Dr. Peter Killian is the most experienced and formally trained physician for this treatment in not only Southwest Idaho but the entire state. His additional year of training in otolaryngology head and neck surgery makes him uniquely equipped to treat rarer conditions such as CSF leaks.

Cerebrospinal Fluid (CSF) Leak Symptoms to Watch For

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Cerebrospinal fluid (CSF) is the fluid surrounding your brain and spinal cord. It protects those areas by providing cushioning and it also nourishes them, making this fluid vital to the proper function of the brain and central nervous system. The dura mater is the lining that keeps the CSF in its place. If the dura mater is weakened or punctured and there is a hole in the thin bone at the top of the sinuses or skull base, a CSF leak may occur.

CSF leaks can be difficult to diagnose in part because some of the common symptoms mimic some of the universal symptoms belonging to the most common ENT diagnosis. Telling the difference between a runny nose from allergic rhinitis from that of a CSF leak requires expert attention.
Common symptoms of a cerebrospinal fluid leak include:
  • Runny Nose. Also called CSF rhinorrhea, a runny nose caused by a CSF leak is usually from one side of the nose and may increase with leaning the head forward or straining. CSF is watery and clear, and if a sample can be collected, it can be used to confirm the diagnosis. (See our pages for other causes of a chronically runny nose.)
  • Headache. CSF leak may lead to intracranial hypotension and headache.
  • Post-Nasal Drip. With a CSF leak post-nasal drip (PND) symptoms is common as CSF drips down into the back of the throat.
  • Neck Pain and Stiffness. Meningitis may occur if bacteria from the nose travel into the intracranial space causing a life threatening infection.
  • Drainage from the Ear. Also called csf otorrhea, this is another way cerebrospinal fluid may drain. Build up in the middle ear may cause muffled hearing or ringing.
  • Reduced or Lost Sense of Smell. Injury to the central portion of the skull base can damage the olfactory nerves. There also may be a salty or metallic taste in the back of the throat.
  • Nausea and Vomiting. This may occur with infection or meningitis.
  • Sense of Imbalance or Dizziness. Due to intracranial hypotension.

If these symptoms have been persistent call Treasure Valley Nasal and Sinus Center at (208) 593-4484 or contact us today so we can assist with an accurate diagnosis and treatment.

Cerebral Spinal (CSF) Leak Diagnosis

A CSF leak can be difficult to detect often leading to misdiagnosis or delayed diagnosis. Diagnosis starts with a thorough history and physical exam. If a sample can be collected, it can be sent for specific laboratory testing to confirm the presence of a CSF leak. Specific imagining studies such as Computed tomography (CT) and Magnetic resonance imaging (MRI) scans may be ordered to evaluate the skull base. Cisternograms can detect abnormal CSF flow through a skull base defect and a pledget test can be used to collect trace amounts of CSF that leak into the nose allowing detection of particularly difficult to detect leaks.

If Dr. Killian, your ENT and skull base specialist, has determined that a CSF leak is causing your symptoms, he can then work with you on treatment.

Cerebrospinal (CSF) Fluid Leak Treatment and Surgery

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Not all CSF leaks require surgery. Non-surgical treatments include:
  • Bedrest. Keeping your head and spine in an aligned, horizontal position can prevent further damage to the meninges and allow existing damage to repair itself. This posture can also provide headache relief.
  • Pain Relief. Moderate or severe headaches may be present, as well as neck pain. Both may be relieved with pain medication. Please note that, while severe headaches may be present, migraine remedies--including migraine medication--are not helpful and may delay diagnosis of a true CSF leak.
  • Oral or Intravenous (IV) Hydration. It is important to keep hydration high, allowing the body to use that hydration to maintain normal CSF levels and pressure.
  • Oral of Intravenous (IV) Caffeine. Caffeine can serve two purposes. It can help reduce the headaches that accompany a CSF leak, and it is also thought to improve the body’s natural production of cerebrospinal fluid in order to keep CSF pressure in a normal range.
  • Epidural Blood Patch and Fibrin Sealant (Glue). If the CSF leak is fairly small, blood and/or a substance called fibrin (a protein that encourages blood clotting) can be injected at the source of the leak. Natural blood clotting, strengthened by the fibrin glue, can patch the leak as the body’s natural processes finish the repair.

If conservative measures fail or there is a more serious CSF leak surgical intervention may be required. To learn more about the surgical repair of CSF leaks, see our Nasal and Sinus Surgery page.

Dr. Peter Killian and the team at Treasure Valley Nasal and Sinus Center will help you understand your ear, nose, and throat disorders and will design a medical
protocol to offer you relief from the ENT diseases affecting your life.


To learn more about why Dr. Peter Killian is the best and most qualified sinus surgeon in the state of Idaho to perform these procedures, read more about his education, training, and experience here or call us at (208) 593-4484. If you are concerned you may have a CSF leak, contact us at Treasure Valley Nasal and Sinus Center. We’re ready to help.  We partner with St. Alphonsus and St Luke’s Meridian hospitals.
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