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67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

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Spontaneous intracranial hypotension: a case series of underlying causes

Meeting Abstract

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  • Christian T. Ulrich - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland
  • Jens Fichtner - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland
  • Christian Fung - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland
  • Michael Fiechter - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland
  • Jan Gralla - Department of Neuroradiology, Inselspital, University Hospital Bern, Switzerland
  • Werner Z’Graggen - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland; Department of Neurology, Inselspital, University Hospital Bern, Switzerland
  • Andreas Raabe - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland
  • Jürgen Beck - Department of Neurosurgery, Inselspital, University Hospital Bern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.18.02

doi: 10.3205/16dgnc206, urn:nbn:de:0183-16dgnc2061

Veröffentlicht: 8. Juni 2016

© 2016 Ulrich et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

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.