gms | German Medical Science

Objective: Spontaneous spinal CSF leaks are rare (5/100.000/year). They are treated conservatively by bed rest, by epidural blood patching or by surgical exploration. Surgical treatment is indicated in cases of failure of interventional treatment, especially in cases of large dural defects or in cases where inability to clearly locate the leakage by imaging methods necessitates surgical exploration. The aim of our case series was to assess the clinical outcome after surgical treatment.

Method: Our clinical database was reviewed for patients with spontaneous spinal CSF leaks who underwent surgical exploration between 2010 and 2013. Symptoms, imaging methods, surgical therapy, intraoperative findings and clinical outcome were reported.

Results: we identified 5 patients (4f /1m) with a mean age of 62 yrs (39 to 75 yrs) with spontaneous spinal CSF leaks who underwent surgical treatment. Two patients received surgery after failure of interventional treatment. Three patients had typical symptoms of intracranial hypotension. One patient suffered from exhaustion and listlessness, one patient had a neurological deficit because of a hygroma. Medical histories revealed mild head trauma a few weeks prior to treatment in one pat. And previous surgery of a cervical neurinoma in another patient. In the other 3 patients past medical histories were inconspicuous. Preoperative imaging showed no clear CSF leak in one case, and suspicion of a CSF leak in 2 cases on MRI which were confirmed in CT-myelography. In another case the CSF leak could only be identified in CT-myelography. One patient had a confirmed CSF leak on MRI. In two cases the CSF leak was localized in the lower cervical spine, in 3 cases in the middle/ lower thoracic spine. A clear CFS leak could be identified intraoperatively in 3 cases, in one case there was CSF flow at the beginning of surgery but a clear leak could not be identified. In one case no clearly CSF leak was found. In all cases preoperative symptoms improved after surgery. A recurrent CSF leak 4 weeks after surgery necessitated a revision in one patient.

Conclusions: Main localization for spontaneous CSF leaks was the lower cervical and the middle/ lower thoracic spine. In only one case the CSF leak could be diagnosed with MRI only, in most cases a myelography had to be performed. In all cases the preoperative symptoms improved after operation. Surgical treatment is an effective treatment of spontaneous CSF leaks in cases of refractory symptoms after conservative or interventional treatment.