Artikel
Lumbar infusion testing in spontaneous intracranial hypotension before and after microsurgery of spinal CSF leaks – an international consecutive cohort study
Lumbale Infusionstests bei spontaner intrakranieller Hypotension vor und nach mikrochirurgischer Versorgung eines Duralecks – eine internationale konsekutive Kohortenstudie
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Autoren
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Luisa Mona Kraus
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Jürgen Beck
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Levin Häni
- Inselspital, Universitätsspital Bern, Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Bern, Schweiz
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Andreas Raabe
- Inselspital, Universitätsspital Bern, Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Bern, Schweiz
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Christian Fung
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Spontaneous intracranial hypotension is an under-recognized diseases caused by spinal CSF leakage. Diagnostic approaches include dynamic CSF studies by lumbar infusion testing. Specific alterations in lumbar infusion testing have been found in patients with SIH. The aim of this study was to compare lumbar infusion test parameters pre- and post-microsurgical closure of a spinal CSF leak in SIH.
Methods: The analysis included all patients with a proven spinal CSF leak who presented to the authors’ institutions between 2018 and 2020. All patients who underwent lumbar infusion testing prior to and after microsurgical closure of a CSF leak were included. A strict stepwise diagnostic protocol was applied including cranial and spinal MRI imaging and dynamic myelography to localize the spinal CSF leak. Postoperatively, patients received spinal MR imaging to exclude spinal extrathecal fluid collection. Lumbar infusion testing yielded resistance to CSF outflow (RCSF), lumbar pressure at baseline and plateau (ICPbaseline/ICPplateau), pulse amplitude at baseline and plateau (ICPbaseline/ICPplateau), pressure-volume-index (PVI) and the elastance coefficient.
Results: Eight patients were included in the analysis. Orthostatic headaches were the main symptom in all patients preoperatively. At postoperative re-admission orthostatic symptoms had entirely vanished. Symptoms at re-admission included diffuse headaches (n=7), nausea (n=3) and papilloedema (n=1). MR imaging did not show extrathecal fluid collection in seven patients, one patient did not receive MR imaging. Comparing post to pre-surgical lumbar infusion testing parameters mean RCSF increased from 6.98 mmHg/(ml/min) to 13.60 mmHg/(ml/min), mean ICPbaseline increased from 4.54 mmHg to 16.37 mmHg, ICPplateau increased from 19.31 mmHg to 31.16 mmHg, AMPbaseline increased from 0.22 mmHg to 0.31 mmHg, AMPplateau increased from 1.15 mmHg to 2.51 mmHg and the elastance coefficient increased from 0.10 ml-1 to 0.22 ml-1. PVI decreased from 55.40 ml to 12.53 ml.
Conclusion: Microsurgical closure of a spinal CSF leak changed lumbar infusion testing parameters towards a normalization. Findings of single parameters were comparable to healthy individuals. Lumbar infusion testing may offer a diagnostic tool to exclude persisting spinal CSF leakage in postoperative patients without the need of radiation exposure.
