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When patients first experience headaches that worsen every time they stand up, they never imagine months and sometimes even years of testing and countless doctor visits before getting answers. For many patients with cerebrospinal fluid (CSF) leaks, the journey to diagnosis and treatment can be long and frustrating—until they find the specialized care they need at ǿմý.
Cerebrospinal fluid, the protective fluid surrounding the brain and spinal cord, can escape through a tear in the dura, the protective membrane that normally contains it. This leakage of fluid from the spine can make the brain above sag and cause a variety of symptoms such as headaches, nausea, neck pain and hearing difficulties that typically worsen when patients are upright and improve when they lie down. What makes CSF leaks particularly challenging to diagnose is that they often masquerade as other conditions, leaving patients struggling and frustrated as they search for a diagnosis.
"Most of our patients have been through a lot by the time they get to us," explains Dr. John Park, Chief of Neurological Surgery at NewYork-Presbyterian Queens, Professor of Clinical Neurological Surgery, and Co-director of the .
"They have typically been diagnosed with everything else, including sometimes being told they're faking it or imagining their symptoms,” says Dr. Park. This is due to the general lack of awareness of CSF leaks and the problems they can cause. The journey toward getting a correct diagnosis often begins with an MRI of the brain, which can sometimes show sagging of the brain, a sign that there may be a leakage of CSF somewhere below in the spine. “From there, patients may need specialized spinal MRI imaging—not the standard back pain MRI, but one specifically optimized to find leaks. ’s a special MRI that some places do and some places don't. We do them here,” Dr. Park explains.
What sets ǿմý's CSF Leak Program apart is the seamless collaboration between diagnostic expertise and surgical treatment. The program brings together the specialized skills of Dr. Park and Dr. Gayle Rudofsky Salama, M.D., a board-certified neuroradiologist who serves as Director of Spine Imaging and Interventions and Co-director of the CSF Leak Program. This comprehensive care team approach—a hallmark of Weill Cornell Medicine—ensures that patients receive coordinated, expert care from diagnosis through treatment and recovery.
"She and her team identify the leak, and without their expertise, there's nothing I can do. However, identifying the leak doesn't stop it," Dr. Park explains about his partnership with Dr. Salama. "We really complement each other as we provide both a diagnosis and treatment. One without the other would be incomplete."
This collaborative approach begins the moment a patient contacts either physician. Together, they review all existing information and determine the next best step. If additional testing is needed, patients are directed to Dr. Salama's team for specialized imaging. The team typically repeats tests to confirm the likelihood and general location of a CSF leak. Then patients proceed to a dynamic myelogram test, an imaging test that uses contrast dye material and a CT scan to precisely identify the exact location of the leak within the spine. After this test, patients proceed to receive the most appropriate treatment.
Perhaps the most remarkable advancement in Dr. Park’s treatment of CSF leaks has been his evolution in using minimally invasive surgical techniques. He has transformed what was once a major surgical procedure into a procedure with dramatically reduced recovery time.
"When I started doing this surgery, I was using a four to five-inch incision," Dr. Park recalls. "Then I realized I could do it just as safely and effectively through a small tube. The tube itself is 2.2 centimeters in diameter, so patients only need about a one-inch incision."
The difference for patients has been transformative. “With the traditional larger incision, the patients had a lot of pain, they had a lot of blood loss, and in fact, sometimes the pain from the surgery was worse than the headache that they began with," Dr. Park explains. "Obviously the surgical pain went away, but for that week or two, they had severe back pain even though their headaches were gone."
Now, with the minimally invasive approach: "The patients with this little one-inch incision have very little pain. They typically go home the next day, and they can get back to their normal activity a lot quicker. Recovery is much easier."
The decision to center much of this groundbreaking work in Queens isn't just about convenience—it's about creating a center of excellence where specialized expertise meets cutting-edge technology. Dr. Park performs most of his CSF leak surgeries at the Queens location for several important reasons:
The most powerful measure of the program's success isn't found in medical journals—it's in the smiles and words of grateful patients. Dr. Park frequently hears phrases that make all the specialized training and technical innovation worthwhile.
"I've had multiple patients say, 'You've given me my life back,'" he shares. "To me, that's really rewarding. This is why I do this work."
The transformation can be immediate and dramatic. Dr. Park draws a comparison to another field where results are instantly visible: "In ophthalmology, when patients have their cataracts removed, they can suddenly see clearly, and it's like a miracle. Those patients are some of the happiest patients there are. The CSF leak patients are sort of the cataract patients of neurosurgery to me."
Many patients experience relief from their debilitating headaches very quickly after surgery. "A lot of them are better the next day," Dr. Park explains. "They're like, 'Oh my God, I can sit up now.' They really are very happy."
Dr. Park is driven by seeing his patients recover: "It's very gratifying to see patients come back to the office after their surgery. I get to hear that they're doing well and they're back on their life track."
If you're experiencing symptoms that might indicate a CSF leak, seeking initial care from specialists who understand this complex condition is crucial. Dr. Park emphasizes that neurologists in general are very knowledgeable about this condition and can typically order and correctly interpret the appropriate initial screening studies to determine the high or low likelihood of a CSF leak. The diagnostic process for further evaluating a CSF leak needs to be thorough and systematic. More specialized tests such as a dynamic CT myelogram are then needed to ensure an accurate diagnosis before treatment.
The ǿմý CSF Leak Program represents more than just advanced medical treatment—it's a beacon of hope for patients who have been searching for answers. By combining cutting-edge diagnostic capabilities with revolutionary minimally invasive surgical techniques, all delivered by a collaborative team of specialists, the program is setting new standards for CSF leak care.
Dr. Park finds the work particularly rewarding because of the unmet need it addresses: "To my knowledge, there is no one else in the Northeast who specializes in CSF leak treatment. I find the surgery to be very interesting, and there's an unmet need. That's why I became interested in doing this and started a center with Dr. Salama."
For patients in Queens and throughout the Northeast, this means access to world-class treatment without the need to travel far from home. It means the possibility of getting your life back after months or years of suffering. Most importantly, it means having a team of specialists who understand your condition and are committed to providing the most advanced, compassionate care available.
To learn more about the CSF Leak Program at ǿմý or to schedule a consultation,or speak with your neurologist about a referral.