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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Cerebrospinal fluid leaks in spontaneous intracranial hypotension are associated with reduced cerebrospinal fluid outflow resistance on lumbar infusion testing

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  • Levin Häni - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Christian Fung - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Timo Miesbach - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Christopher Marvin Jesse - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Andreas Raabe - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Jürgen Beck - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV074

doi: 10.3205/18dgnc075, urn:nbn:de:0183-18dgnc0752

Published: June 18, 2018

© 2018 Häni et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Spinal cerebrospinal fluid (CSF) leaking causes spontaneous intracranial hypotension (SIH). The diagnosis of SIH can be challenging, requiring multiple imaging procedures. Aim of the study was to assess parameters of CSF fluid dynamics by lumbar infusion testing in patients with and without proven spinal CSF leak. This represents a validation study of our recently published data.

Methods: We included consecutive patients with suspected SIH treated from January 2012 to August 2017. A CSF leak was regarded as "proven" in case of extrathecal contrast accumulation after intrathecal contrast application, either on spinal MRI, myelography or post-myelography-CT, or by direct intraoperative visualization of the leak. Computerized lumbar infusion testing with a constant rate of 2ml/min was performed to analyze parameters of CSF fluid dynamics including CSF outflow resistance (RCSF).

Results: 115 lumbar infusion tests were performed in 111 patients with complete clinical imaging. 38 (63.3%) with a proven leak had an opening pressure higher than 4.4mmHg (current threshold of the ICHD society for SIH). RCSF in patients with a proven CSF leak (n=60) was 6.94mmHg/(ml/min) (95%-CI 4.84-9.04mmHg/(ml/min)) compared to 9.33mmHg/(ml/min) (95%-CI 8.01-10.65mmHg/(ml/min)) (p=0.001) in patients without a CSF leak (n=51). Sensitivity and specificity for a RCSF cutoff of ≤4.45mmHg/(ml/min) were 56.7% and 87.3% (area under the ROC curve 0.682), respectively. Median opening pressure in patients with a CSF leak was 6.58mmHg compared to 9.61mmHg in patients without a leak (p=0.001). Plateau pressure, pulse amplitude and pressure-volume index were significantly different between groups (p=0.005, 0.003 and <0.001, respectively).

Conclusion: Parameters of CSF fluid dynamics assessed by computerized lumbar infusion testing showed a strong association with the existence of a spinal CSF leakage and can easily be implemented in the diagnostic workup of SIH.