Cerebrospinal Fluid Disorders
The University of Maryland Medical Center (UMMC) offers expert care and advanced treatment options for many cerebrospinal fluid (CSF) disorders.
Cerebrospinal Fluid Disorders Clinic
The CSF Disorders Clinic at UMMC uses cutting-edge, minimally invasive procedures to treat your CSF disorder.
Our experienced team develops personalized care and treatment plans to reach the best outcome for each patient.
With a commitment to compassionate care and a proven track record of successful outcomes, we are dedicated to improving the quality of life for all patients with CSF-related conditions.
Types of Cerebrospinal Fluid Disorders
Cerebrospinal fluid surrounds and protects the hollow spaces of the brain and spinal cord. It’s also found between thin tissue layers that cover the brain and spinal cord (the meninges). CSF washes out impurities from the brain, transfers nutrients and provides protective cushioning in case of a sudden impact or injury.
While there are several kinds of CSF disorders, some common conditions we treat include:
- Normal pressure hydrocephalus (NPH) – a condition where cerebrospinal fluid accumulates in the brain. This typically affects the elderly and leads to symptoms like cognitive decline, difficulty walking and bladder control issues. Often the cause of NPH is unknown, but it can result from head trauma or infection. Misdiagnosis is common because the symptoms are similar to those of Alzheimer's and Parkinson's. Without treatment, the condition may worsen and become life-threatening.
- Treatment – minimally invasive surgery to implant a tube, called an eShunt, between a vein in the neck and the base of the skull to drain the fluid.
- Idiopathic intracranial hypertension (IIH) – known as pseudotumor cerebri, it's a rare condition when there is a buildup of CSF, causing increased pressure in the skull and the optic nerve. Common symptoms include headaches, vision changes and ringing in the ears. IIH is more prevalent in obese women between the ages of 20 and 50. Early diagnosis and treatment are crucial to prevent potential vision loss, typically involving measures to reduce the CSF pressure.
- Treatment – surgery may be recommended if weight loss and medication are ineffective. A spinal fluid shunt, which is a long, thin tube, can be placed in the brain to drain excess CSF. Another option is eye surgery called an optic nerve sheath fenestration, which requires small incision(s) around the optic nerve to drain CSF.
- Spontaneous intracranial hypotension (SIH) – also known as spontaneous low-pressure headaches, it's a rare condition that occurs when there is a leak or tear in the spinal dura, resulting in pressure from a loss of CSF and low CSF. It can affect all ages, male and female. SIH leads to headaches that worsen when upright and improves when lying down.
- Treatment – an epidural blood patch, which involves injecting the patient's blood into the spinal canal to seal the leak. If that doesn't work, surgery may be recommended to remove a piece of bone to patch the dura or for shunt valve replacement.
- CSF spinal venous fistulas (CVFs) – an abnormal connection between the spinal subarachnoid space and nearby veins, leading to CSF leakage. This condition is typically found in the middle section of the spine (thoracic spine) and is a newly recognized cause of SIH. Diagnosis requires special imaging. Treatment options include injecting patient’s blood near the spinal cord (epidural blood patching) and surgical ligation.
- Treatment – surgical intervention, which is the most effective treatment, involving ligation of the nerve root and associated veins. Other options include laminectomy, facetectomy, and transvenous embolization (see below for details).
CSF Disorder Treatments
We use state-of-the-art technology and the latest research to deliver innovative treatments, from minimally invasive surgical procedures to advanced medical therapies.
Surgeries that may be used to treat your CSF disorder include:
- Craniotomies – removing a portion of the skull to access the brain
- Endoscopic endonasal – minimally invasive surgery where a surgeon goes through the nose to access the base of the brain
- Transvenous embolization – relatively new, noninvasive surgery that prevents blood from flowing to certain blood vessels
Not all CSF disorders require surgery. Your neurology care team will advise you on what treatment would be best.
Make an Appointment
If you need consultation on a CSF disorder, call us at 410-328-6034 to make an appointment. We're located in downtown Baltimore, convenient to the city and surrounding counties:
Neurosurgery at UMMC
22 S. Greene St, 12th Floor
Baltimore, MD 21201