The prognosis for most patients with spinal cerebrospinal fluid leaks is favorable when the diagnosis is recognized and appropriate treatment is offered. Centers that see a larger volume of cases have greater familiarity with interpretation of imaging, with refined imaging techniques and with the range of available treatments.
For those with leaks resulting from medical procedures, the vast majority do very well.
Lumbar punctures that cause a headache respond to lumbar epidural blood patch (EBP) most of the time, but occasionally an EBP will need to be repeated or an epidural patch with fibrin sealant is used. On rare occasions, a surgical repair is needed.
Inadvertent punctures or tears of the dura from epidural injections are usually addressed successfully with one or more epidural blood patches, however there are reported cases in which a surgical repair was needed.
Dural defects that occur during spinal surgery often require an open surgical repair.
Spontaneous spinal CSF leaks appear to be associated with either spinal pathology and/or abnormal dura in the majority of cases. These patients do well overall, although some may require several procedures.
Some patients with spontaneous leaks have symptoms that resolve spontaneously in a matter of hours, days or weeks without ever seeking medical care.
A substantial percentage of patients respond favorably to one or more epidural blood patching procedures. When epidural blood patching is unsuccessful or if symptoms recur, spinal imaging findings help to guide further treatment. Epidural patching with fibrin sealant may be directed at the leak location or a surgical repair may be the best option.
Surgical repair of spinal CSF leaks have good success rates in the hands of experienced neurosurgeons.
Rebound Intracranial Hypertension, elevated CSF pressure, may occur following treatment. This usually presents with a different pattern of headache in location, quality and positional aspect, but is not always readily distinguished from the headache associated with intracranial hypotension (low volume of CSF in the brain). Associated symptoms may be similar or dissimilar from pre-treatment. Because research on this has been limited to date, the natural history and best treatment approaches have not yet been clarified. Acetazolamide is the medication prescribed most often, but several other medications are also in use.
It should be noted, however, that while outcomes tend to be good in experienced hands, many patients do not receive timely and appropriate care.
A subset of patients continues to have persistent symptoms and associated disability despite numerous interventions.