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Spinal CSF Leak Program


Welcome to the Spinal Cerebrospinal Fluid (CSF) Leak Program at Kaiser Permanente in Northern California where we have an expert multidisciplinary team of physicians trained in seeing patients with spinal CSF leaks. Our team will work with you to identify the correct diagnosis and treatment plan.


Spinal CSF leaks stem from small holes in the outer layer of the spinal canal, which result in a loss of spinal fluid and low intracranial pressure. The leaks can either be due to a prior medical procedure/surgery or they can be spontaneous, yielding the term spontaneous intracranial hypotension. Clinical symptoms can vary but are often associated with positional headaches that are worse while upright and improve when lying down. Historically, this condition was thought to be rare, but the medical community now recognizes and better understands the condition.

There are 3 main causes of spontaneous spinal CSF leaks:

  • Mechanical tears from sharp discs in the spine. These usually occur in the thoracic spine and result in fast CSF leaks.
  • Ruptured perineural diverticula (cysts). These are spinal outpouchings that result in fast or slow CSF leaks when ruptured.
  • CSF-Venous fistula: This entity has recently been described and is an abnormal connection between a perineural diverticulum and a spinal vein. As these are fistulas, they result in very fast CSF steal phenomenon.


Our multidisciplinary team is trained in advanced imaging techniques to diagnose spinal CSF leaks. These include various forms of CT myelography to diagnose fast or slow CSF leaks. We also can perform specialized myelograms to identify CSF venous fistulas. Our team will determine the best imaging technique for each patient, being guided by evidence-based medicine.

After we identify the spinal CSF leak, we can perform targeted blood patches at the exact site of the spinal CSF leak, typically using the CT scanner for guidance. This accuracy and precision can provide the best chances of sealing the spinal leak. In cases where surgery is needed, our expert neurosurgeons will direct treatment.


Appointments can be made by your Kaiser Permanente doctor.



Mark Mamlouk, MD
Santa Clara Neuroradiology (Director)

Peter Jun, MD
Santa Clara Neuroradiology

Peter Shen, MD
Santa Clara Neuroradiology

Robert Ochi, MD
Roseville/Sacramento Neuroradiology

Brian Dahlin, MD
Sacramento Neurointerventional Radiology

Mark Sedrak, MD
Redwood City Neurosurgery