Artikel
Spontaneous intracranial hypotension: a case series of underlying causes
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Spontaneous intracranial hypotension (SIH) is a rare but increasingly diagnosed condition. Low cerebrospinal fluid (CSF) pressure due to a dural leakage causes orthostatic headache. The nature, aetiology, and location of the CSF leak itself are currently unknown and are thought to be spontaneous or idiopathic in most cases.
Aim: We present a case series with proven CSF leaks in which a systematic and meticulous search revealed the underlying sources of dura-perforating pathologies causing SIH.
Method: A consecutive series of 13 patients with symptoms of non-self-limiting intracranial hypotension were evaluated for a systematic diagnostic work-up from February 2013 to July 2015. We performed a spine focused, stepwise escalating imaging set. Microsurgical exploration under intraoperative electrophysiological monitoring to elucidate the underlying cause of the CSF leak was performed in all 13 cases.
Results: We identified 13 patients with SIH and imaging signs of spinal dural perforation. In 10 cases a calcified micro-spur extruding out of the disc space was identified perforated the dura and arachnoid. In 3 cases a arachnoidal cyst at the axilla of the exiting spinal nerve root with a slit in the dura was identified as CSF-leakage. All 10 micro spurs and 3 cysts were micro-surgically approached, the dura was sealed, and the CSF leak ceased immediately.
Conclusions: The aetiology of the CSF leak in SIH remains obscure. Here we present 14 patients in which a systematic spinal work-up, including microsurgical exploration, revealed dural slit caused by a perforating micro spurs or arachnoid cysts at the exiting nerve root. The dura-perforating micro spurs were a more frequent cause of SIH than arachnoid cysts. Both were definitive, and readily treatable causes of SIH.