CSF Leaks

Spinal CSF leaks lead to intracranial hypotension (low pressure). This MRI brain image shows typical
Spinal CSF leaks lead to intracranial hypotension (low pressure). This MRI brain image shows typical features of a CSF leak, including brainstem sag (white arrow), cerebellar tonsillar herniation (red arrow), and an enlarged pituitary gland (blue arrow).

Cerebrospinal fluid (CSF) is the liquid that flows within and around the brain, spinal cord, and spinal nerves to cushion and nourish them.  CSF is normally contained within a sack made of dura, the tough membrane that surrounds the brain and spinal cord. When a hole develops in the dura, CSF leaks out of the sack and can cause significant debilitation, including headaches (which sometimes improve when lying down and worsen when upright) or other neurological symptoms.

CSF leaks can occur along the spine or at the base of the brain. Patients can often go undiagnosed, or misdiagnosed, for many years. Our team of subspecialized world-class Weill Cornell Medicine physicians are trained to diagnose the condition, identify the site of the leak (the dural tear),  and successfully treat it with a wide variety of approaches.  Our multidisciplinary team delivers the highest level of comprehensive care to our CSF leak patients. Once they are accurately diagnosed, patients can make a full recovery. (See more about our multidisciplinary CSF Leak Program.)

What Causes a CSF Leak?
CSF leaks often occur spontaneously, although they can result from minor or major trauma. Patients with connective tissue disorders may be at higher risk for CSF leak due to intrinsic weakness of their dura.  A spinal leak can also occur as a complication of a surgery or procedure, including lumbar punctures and pain management procedures.  An injury to the head or face, especially if it includes a skull fracture, as well as complications of endonasal surgery, can sometimes result in a cranial CSF leak. A CSF leak can also occur in a patient with increased intracranial pressure (idiopathic intracranial hypertension, or IIH), which can lead to dural breakdown. Identifying leak patients with underlying high intracranial pressure is important as part of their treatment is to lower the pressure to avoid CSF leak recurrence. (See Diagnosing a CSF Leak.)

“You know when you get a ‘brain freeze’ from eating ice cream too fast? That’s what it felt like,” says Kelly Olivo. The 55-year-old mother of four lives in the hamlet of Slate Hill, about 75 miles northwest of New York City, and life was good — she...

Our Care Team

  • Chief of Neurological Surgery, NewYork-Presbyterian Queens
  • Co-director, Weill Cornell Medicine CSF Leak Program
Phone: (718) 670-1837
  • Director, Spine Imaging and Interventions
  • Co-director, Weill Cornell Medicine CSF Leak Program
Phone: 646-962-5757
  • Associate Attending Neurologist, NewYork-Presbyterian Hospital
  • Associate Professor of Neurology, Weill Cornell Medical College
Phone: (212) 746-7038

Reviewed by: Gayle Salama, MD, and John Park, MD, PhD
Last reviewed/last updated: February 2023

Weill Cornell Medicine Neurological Surgery 525 East 68 Street, Box 99 New York, NY 10065 Phone: 866-426-7787