Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

Abstract

All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3-58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Frequency of spontaneous intracranial hypotension in the emergency department

“…However, this was not a communitybased study and the incidence figure is only a gross approximation. Prior studies on the epidemiology of spontaneous intracranial hypotension are not available for comparison, with the exception of one unpublished study identifying two patients with spontaneous intracranial hypotension in a community of approximately 100,000 persons in southeastern Minnesota for a prevalence of approximately 1 in 50,000 [4]. The frequency of spontaneous intracranial hypotension in our ED was likely an underestimation because we primarily used abnormal CT scanning to identify patients with spontaneous intracranial hypotension and no special effort was made to identify patients with spontaneous intracranial hypotension based on clinical characteristics.…”

Multi-level Disruption of the Spinal Nerve Root Sleeves in Spontaneous Spinal Cerebrospinal Fluid Leakage. Two Case Reports.

“…CSF leaks from spinal meningeal cysts have been observed by neuroimaging techniques and also by direct surgical explorations. 1,23,24,26) Radioisotope cisternography is less accurate and less sensitive for demonstrating the anatomical structures than computed tomography (CT) myelography and magnetic resonance (MR) imaging, but may directly reflect the CSF dynamics. We treated two patients with spontaneous spinal CSF leaks, in whom radioisotope cisternography showed unique findings of diffuse dispersion out of the extraspinal canal via the nerve root sleeves.…”

Regional Anesthesia and Pain Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test)

“…Other symptoms include blurred vision, diplopia, retro-orbital pain, neck pain and tinnitus. 2,14 The reduction of CSF volume through the dural mater is counteracted by increased cerebral venous blood volume which contributes further to the headache. Increased dural blood volume is demonstrated on MRI as diffuse pachymeningeal enhancement.…”

“…13 Meningeal diverticula or cysts are the usual cause of such leaks. 2,13 The presenting complaint of SIH is postural headache caused by tension on pain-sensitive structures in the meninges. Other symptoms include blurred vision, diplopia, retro-orbital pain, neck pain and tinnitus.…”

“…1 It is usually caused by CSF leak from a tear in a spinal nerve root sheath, a perineural cyst, or a spinal arachnoid diverticulum. 2 Precise determination of the spinal level of the leak is important in the diagnosis and treatment of SIH. Several different imaging modalities may be used to assist in making the diagnosis, such as spinal magnetic resonance imaging (MRI) 3 isotope cisternogram, 4 computed tomography (CT) with contrast, 4 CT myelography, 5 and MRI myelography.…”