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The nature of the CSF leak is a circumscribed longitudinal slit at the ventral, lateral, or dorsal dura mater. An extradural pathology, diskogenic microspurs, was the single cause for all ventral CSF leaks. These findings challenge the notion that CSF leaks in SIH are idiopathic or due to a weak dura. Microsurgery is the treatment of choice in cases with intractable SIH.

Background and Purpose-Endovascular therapy of acute ischemic stroke has been shown to be beneficial for selected patients. The purpose of this study is to determine predictors of outcome in a large cohort of patients treated with intra-arterial thrombolysis, mechanical revascularization techniques, or both. Methods-We prospectively acquired data for 623 patients with acute cerebral infarcts in the carotid artery territory who received endovascular treatment at a single center. Logistic regression analysis was performed to determine predictors of outcome. Results-Median National Institutes of Health Stroke Scale (NIHSS) at admission was 15. Partial or complete recanalization was achieved in 70.3% of patients; it was independently associated with hypercholesterolemia (Pϭ0.02), absence of coronary artery disease (Pϭ0.023), and more proximal occlusion site (PϽ0.0001). After 3 months, 80.5% of patients had survived, and 48.9% of patients reached favorable outcome (modified Rankin scale score 0 -2). Good collaterals (PϽ0.0001), recanalization (Pϭ0.023), hypercholesterolemia (Pϭ0.03), lower NIHSS at admission (Pϭ0.001), and younger age (PϽ0.0001) were independent predictors for survival. More peripheral occlusion site (PϽ0.0001), recanalization (PϽ0.0001), hypercholesterolemia (Pϭ0.002), good collaterals (Pϭ0.002), lower NIHSS (PϽ0.0001), younger age (PϽ0.0001), absence of diabetes (Pϭ0.002), and no previous antithrombotic therapy (Pϭ0.036) predicted favorable outcome. Time to treatment was only a predictor of outcome, when collaterals were excluded from the model. Symptomatic intracerebral hemorrhage occurred in 5.5% and was independently predicted by poor collaterals (Pϭ0.004). Conclusions-Several independent predictors for outcome and complications were identified. Unlike in intravenous thrombolysis trials, time to treatment was a predictor of outcome only when collaterals were excluded from the model, indicating the important role of collaterals for the time window. (Stroke. 2012;43:1052-1057.)Key Words: intra-arterial thrombolysis Ⅲ outcome Ⅲ predictors Ⅲ anterior circulation I n 1981, Zeumer et al performed a successful local intra-arterial thrombolysis (IAT) in a patient with basilar artery occlusion. 1 This kindled interest in IAT, and randomized trials showed a benefit of IAT for acute ischemic stroke with middle cerebral artery occlusion. [2][3][4] Various case series showed that IAT can be safely and efficaciously performed in clinical practice. 2,4,5 In selected stroke patients, ie, in patients with hyperdense middle cerebral artery on computed tomography, IAT may be more effective than is intravenous thrombolysis (IVT) with recombinant tissue-type plasminogen activator. 6 Today, endovascular stroke therapy uses both drugs, mostly recombinant tissue-type plasminogen activator or urokinase, and mechanical means for thrombus dissolution and removal to enhance the chances of vessel recanalization. [7][8][9][10] In the decision process for treatment and patient selection for endovascular therapy, clinical and ...

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