Medical Malpractice
What is CSF? This abbreviation stands for cerebrospinal fluid. CSF is a clear colorless fluid in the spine and the brain. It is produced by our choroid plexus in the ventricles of our brains. We produce the stuff quickly, and it gets reabsorbed just as quickly. So we might produce 500 ml of CSF a day but we only have around 150 ml in our body at any given time.
Is a Dural Tear Malpractice?
Most of the malpractice cases we have seen involve a CSF leak during spinal surgery, usually surgery to repair a herniated disc, or during endoscopic sinus surgery. These tears do happen during surgery, typically in the absence of negligence. It happens.
A 2024 systematic review of more than 80,000 spine surgery patients found incidental dural tears in about 5% of cases. So the fact that the dura was torn does not, by itself, mean there was malpractice.
Where the negligence comes in is the failure to identify the problem head on or to inadequately repair damage that is causing the spinal fluid to leak.
The plaintiffs’ lawyers in these cases are going to argue that doctors violated the standard of care by failing to identify and repair the tear during the surgery. Some doctors choose to let the tear mend on its own. Is this a good idea?
There are no hard and fast answers. It depends on a variety of factors. It is true that these cerebrospinal fluid leaks quite often seal on their own without complication.
But there are some leaks that a doctor knows or should know have a real risk of getting out of hand and the standard of care requires them to make reasonable calls. A 2026 study of delayed CSF leaks after lumbar surgery underscores the problem. A leak that is not obvious during surgery can show up later and become much harder to deal with.
CSF Leak After an Epidural or Dural Puncture
A CSF leak can also happen after an epidural, spinal anesthesia, or lumbar puncture when the needle punctures the dura. Again, the puncture itself does not necessarily mean there was malpractice.
The classic symptom is a headache that gets much worse when the patient sits or stands and improves when lying down. The malpractice question is usually whether the problem should have been recognized and whether the patient received appropriate treatment once the symptoms developed.
How Can You Make Sure There Is No CSF Leak?
First, there are symptoms of a CSF leak:
- A headache. A CSF leak induced headache is going to get a lot better if you are lying down but will rear its head if you are sitting or standing.
- Patient complains of light sensitivity
- Nausea
- Neck stiffness
- Runny nose
- Drainage out of your ear
You can also test for a CSF leak:
- CT scan or MRI
- Beta 2 transferrin or beta trace protein testing when fluid is leaking from the nose or ear
- CT myelography or other specialized imaging when a spinal CSF leak is suspected
A 2025 meta analysis found that beta 2 transferrin and beta trace protein are both highly accurate tests for identifying cerebrospinal fluid.
No one disagrees that these tests may catch a CSF leak. The question in individual negligence cases boils down to what the doctor should have suspected and what should have been done about that suspicion.
What Happens If a CSF Leak Is Left Untreated?
Again, some CSF leaks resolve on their own. But when they do not, the injuries can be awful.
A persistent leak can cause severe headaches and other neurological problems. A cranial CSF leak can also create a pathway for infection and lead to meningitis. A 2025 review of lumbar spine surgery found a significantly higher risk of postoperative infection in patients who suffered a dural tear.
That does not mean every untreated CSF leak will become catastrophic. But a doctor cannot ignore symptoms suggesting that a significant leak is continuing.
What Is a CSF Leak Case Worth?
Obviously, the value of the case depends on just how serious the injuries are.
A CSF leak that is quickly identified and repaired with no lasting injury is very different from a case where a missed leak leads to meningitis, additional surgeries, permanent neurological injury, or death. The strength of the malpractice case also matters. A serious complication does not automatically mean there was negligence.
Bringing a Claim for Malpractice
Our lawyers handle serious injury medical malpractice cases. Our practice is focused in Maryland. But we handle CSF leak injury and other catastrophic injury and wrongful death medical mistake cases around the country. So there is a real chance we can help you no matter where in the country you are.
To get our thoughts on your claim, it costs nothing. We will be more than happy to discuss it with you at no charge and with no obligation. Call 800-553-8082 or get a free online consultation here.
General Medical Malpractice Information
- Maryland Malpractice Overview: what to expect
- Cauda Equina Syndrome: compression on the spinal nerve roots, an injury that often leads to misdiagnosis lawsuit
- Meningitis-Related Malpractice Suits
- Malpractice Frequently Asked Questions
- Learn More About Hospital Malpractice