Cerebrospinal Fluid Leak Prevention and Treatment

by Andrea Hambly., Olympia, Washington on 2014-11-07 in Craniosacral Therapy

Cerebrospinal fluid is the lifeline of the brain and the spinal cord, delivering nutrients and removing metabolic toxins continuously to keep it healthy and well-functioning. The cerebrospinal fluid is contained within a three-layered membranous sac, referred to as the meninges, which covers the entire central nervous system (brain and spinal cord) as a single unit. Cerebrospinal fluid (CSF) leaks occur when the integrity of the meningeal sac is breached and the CSF escapes the confines of this three-layered membrane. The CSF then leaves the skull through a small channel or weakness in one of the skull bones. CSF leaks need to be resolved as quickly as possible to avoid meningitis caused by the spread of bacteria to the brain through the site of the leak.

What causes a cerebrospinal fluid leak?

The most common causes are trauma to the head or face, and head surgery, including surgical intervention for sinus problems. Some CSF leaks are termed spontaneous.  They are difficult to detect because there are no obvious causes and the leak is intermittent and small. It is quite possible that such leaks occur because traction on the meningeal sac has developed over a long time, sometimes years. Such traction could weaken the sac, especially where it has a strong attachment to the inside of the skull, such as the cribriform plate of the ethmoid bone  (between your eyes), the sella turcica that houses the pituitary gland, and the inside of the occipital bone (the back of your head).

Cerebrospinal fluid leaks may also occur anywhere along the spine.

The causes here may be medical procedures such as a lumbar puncture, vertebral disc prolapse, direct accidental trauma to the spine, or spinal surgery. Since the meningeal sac also has attachments to the 2nd and 3rd vertebrae, as well as the sacrum, traction on the meningeal sac due to subluxation of the spine may cause  a cerebrospinal fluid leak anywhere along the spine.

A cerebrospinal fluid leak can result in many different symptoms.

The cerebrospinal fluid (CSF) serves to buffer the brain, effectively reducing its weight within the skull from approximately 1500 g to less than 50 g.  Moreover, the CSF also brings nutrients to the brain and removes metabolic toxins, thus assuring its health and function. The kinds of symptom a person might experience depends on how much CSF escapes the meningeal sac. With the buffer reduced by a CSF leak, the brain starts to sag toward the only opening in the skull, the foramen magnum, where the spinal cord the skull.  Part of the brain stem, along with the cranial nerves that emerge from it, becomes trapped, distorted, or squeezed. Bruised brain tissue is not a happy camper.   Common symptoms are disturbed vision, distorted sense of smell or taste, impaired hearing, dizziness and loss of balance, fatigue, mood changes, anxiety, disturbed digestion, changes in heart beat and breathing rate, difficulty concentrating,  reduced focus, and impaired memory. Dr. William Garner Sutherland discovered in the early 1900's that the skull bones move.  More importantly, he experienced the myriad of symptoms that may be caused by various pressures to the head bones, that cause them to shift and become stuck.  More...

Current treatment options vary from conservative to surgical.

  • Strict bed rest for up to a week may allow the body to heal small tears on its own.
  • A blood patch covering the meningeal tear may serve to stop the leak while the body repairs the meningeal tear.
  • Surgery is another option for larger tears or if smaller tears don't heal on their own, even with strict bed rest or a blood patch.
  • Lumber puncture to divert CSF flow and stop the CSF leak.

A cerebrospinal fluid leak may recur.

Even though the various treatment options may stop the CSF leak at the time of treatment, leaks may recur if the cause of the original leak has not been removed, or the surgical repair fails.  Of course, a new CSF leak may occur if a person experiences another head or spinal trauma. Acute head  or spinal trauma aside, a tear in the meningeal sac signals a weakness in the membrane itself or at the point where the membrane attaches to one of the cranial (head) bones, the first two vertebrae, or the bottom of the sacrum. This weakness may be caused by acute trauma to the head with fracturing of one of the cranial bones. It may be caused by closed head injuries such as a contrecoup injury, or serious whiplash injury.  Such an injury could quite easily stretch and distort the membrane of the meningeal sac,

Big and small injuries to the head and spine can cause restrictions in the meningeal sac.

We tend to forget that the head takes numerous hits throughout our lives.  Here are just a few examples:
  • Difficult childbirth, setting up the infant for meningeal restrictions
  • Infants fall from a couch, out of the crib, are dropped by the caretaker, or pushed by a sibling.
  • Toddlers lose their balance all the time as they learn to stand, walk, and run.  The head is heavy and often takes a hit.
  • Children fall while climbing, running after the ball, wrestling with their siblings or friends, or lose their balance and smack their heads into the walls or furniture of the home while charging after each other,
  • Children learn how to ride scooters and bicycle and, of course, fall off them.
  • Children take up sports that present endless opportunities for injuries to the head and spine, such as gymnastics, soccer, basketball, skiing, skateboarding, etc.
  • Teenagers become even more serious about sports such as basketball, football, baseball, boxing, rugby, gymnastics, ice hockey, etc.
  • Teenagers learn to drive and are often involved in car accidents.
  • Adults just continue with these activities, or take up new ones
  • Adults face occupational hazards such as the use of heavy equipment, heavy lifting, vibrational machines or platforms, etc
This list serves to remind us how life provides numerous opportunities for injuries, starting as early as childbirth.

Connective tissue restrictions affect our quality of life.

While we recover from these injuries, the body retains memory of each event in the form of connective tissue (fascia, ligaments, tendons, meninges, etc.) restrictions.  Over time we become stiffer, slower, less resilient, less able to do the things we used to do, need to do, or love to do.  We start feeling aches and pains, on and off or continuous.  We develop headaches, have difficulty with mental tasks such as concentration, memory, or focus, and feel frayed around the edges. The meninges, that three-layered membranous sac containing our precious brain and spinal cord, is a form of connective tissue, subject to restriction and distortion, as are all the other types of connective tissue in our bodies such as the fascia, tendons, and ligaments.

Meningeal sac restrictions may ultimately lead to a cerebrospinal fluid leak.

A life time of injuries, small or large, may lead to various meningeal sac restrictions that make it vulnerable to tears, especially at the stress points where it attaches to the inside of the skull bones, the upper neck vertebrae, and the sacrum. To avoid recurrence of the cerebrospinal leak, or future CSF leaks, it is important to help the body release these meningeal sac restrictions.

Craniosacral therapy focuses on cerebrospinal health.

The adverse effects of traction on the meningeal sac were discovered by Dr. William Sutherland in the early 1900's.  Dr. Sutherland was an osteopath, intimately familiar with the body's tissue movements, which he had learned from his teacher, Dr. Andrew Taylor Still. His fascination with skull anatomy led to the discovery that the skull bones move until the day we die.  Moreover, trauma to the head or spine could cause one or more bones to lock up along the suture line and result in varied symptoms besides pain that seemed unrelated to the trauma itself. More investigation by Dr. Sutherland revealed to him the connections between the skull bones, the movable sutures, the meningeal sac, and the cerebrospinal fluid.  The entire system is referred to as the craniosacral system. Dr. John E. Upledger did his own investigations of the craniosacral system, noticing that restrictions in the meningeal sac disrupted the normal flow of the cerebrospinal fluid within it, leading to various pressures on the brain structures with symptoms specific to the structures. Pressure on nerves causes them to signal at a higher, lower, or erratic rate.  We experience this as pain, alterations in vision, hearing, taste, smell, swallowing, voice production, and balance, as well as problems with focus, concentration, and memory.  Moreover, we may experience mood changes, anxiety, or even depression. Dr. Upledger developed a therapy, calling it craniosacral therapy, to help the body to release the meningeal sac restrictions.  He noticed that releasing these restrictions helped to rebalance the flow of the cerebrospinal fluid with a concomitant reduction in the various symptoms.

Craniosacral therapy may help the body to completely heal and avoid recurrence of a cerebrospinal fluid leak.

Craniosacral therapy promises to be of invaluable help in the recovery from cerebrospinal fluid leaks.  This therapy is excedingly gentle yet very effective.  By helping the body to release restrictions in the craniosacral system, as well as in the rest of the body, It promotes general health and well being. This exceedingly gentle therapy, along with energetic unwinding, helps the body to relax and unravel the stresses and strains of daily living, and all the big and small traumas of the past.