Karnataka Sees the 1st Surgical Repair of Spinal CSF Leak Misdiagnosed for Decades at Manipal Hospital Kanakapura Road

BENGALURU, India, April 14, 2026 /PRNewswire/ — In a first-of-its-kind for the Karnataka region and among only the 2nd and 3rd such cases treated in India, Manipal Hospital Kanakapura Road has successfully performed surgical repair of an anterior dural tear in 2 patients with decade-long undiagnosed Spinal CSF leaks.

Both patients, who were in their late 30s, had endured decades of chronic disability and misdiagnosis. They were primarily treated elsewhere for presumed migraine until they finally found relief for the correct cause – Spinal CSF Leak, under the care of Dr. Sharath Kumar G G, Consultant – Radiology and Interventional Neuroradiology.

Spinal CSF Leak and Dural Tear: Why Is Diagnosis So Difficult?

The brain and the spinal cord are covered in a fluid called cerebrospinal fluid, or CSF, which acts as a cushion and keeps pressure inside the skull stable. Spinal CSF leaks occur when there is a tear or hole in the dura, the tough membrane enveloping the spinal cord and brain. This allows the fluid to leak out, causing the brain to lose its cushioning. It causes severe upright headache episodes that may feel like the “worst headache of your life”, worsening while sitting or standing.

When the tear is located on the anterior side (front-facing) of the spinal canal, it is medically known as a ventral dural tear. They are very rare and often elusive, leading to chronic misdiagnosis and long-term suffering. It is mostly attributed to the overlapping of migraine headache symptoms and standard imaging scans failing to detect the leak entirely.

Case 1:

The first patient, 39-year-old Mr. Rajath [name changed] from Chennai had been living with severe headaches for over 12 years since the age of 27. He was treated repeatedly for migraine at multiple healthcare facilities, but his condition slowly deteriorated with additional symptoms of hearing loss and changed gait due to complications caused by iron deposits building up in the brain. He was referred to Dr. Sharath Kumar G G, Consultant – Radiology and Interventional Neuroradiology at Manipal Hospital Kanakapura Road for expert diagnosis and care.

Advanced imaging tests including a myelogram revealed the underlying issue: a ventral dural tear in the cervical spine (C3). An abnormal bone growth had punctured the dura from within, causing fluid to slowly leak for years. The medical team quickly formed a plan and performed a surgical repair of the tear successfully, and the patient made a swift recovery.

Case 2:

The second patient Mr. Hari [name changed], from Shivamogga, arrived in a more critical condition. His undiagnosed CSF leak had persisted for so long that it caused massive bilateral subdural haematomas (large blood clots to form inside his skull), which is a dangerous but under-recognised consequence of prolonged fluid loss and intracranial hypotension. He had experienced severe neurological decline, including drowsiness, inability to respond, and episodes of unresponsiveness, along with psychological distress due to years of unsuccessful treatment.

While referred for management of the brain bleeds, the team led by Dr. Sharath Kumar G G identified the root cause: a ventral dural tear in the dorsal spine; following which a coordinated surgical approach led by Dr. Dhananjaya I Bhat, Consultant – Neurosurgery, Manipal Hospital Kanakapura Road. He safely accessed the affected spinal region, carefully navigating around the spinal cord, and repairing the dural defect while minimising the risk of neurological injury. This addressed, both the spinal leak and its intracranial complications. The patient recovered well and was discharged in stable condition.

Dr. Sharath Kumar G G, Consultant – Radiology and Interventional Neuroradiology, noted, “Both patients had been receiving medications for migraine for years for a condition that could’ve been corrected surgically. These cases remind us that when standard treatment fails repeatedly, we must look deeper and with the right imaging and a specialised team, even the most elusive diagnoses can be uncovered and treated.”

Both patients are scheduled for follow-up within the week. Their recoveries mark not just a personal turning point, but a landmark moment for neurosurgical care in Karnataka, proof that with specialist expertise and the right diagnosis, years of suffering can be brought to an end.

For more information, please visit https://www.manipalhospitals.com/kanakapuraroad/doctors-list/interventional-neuroradiology/

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