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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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Acute versus chronic spontaneous intracranial hypotension show different patterns of CSF dynamics

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  • Levin Häni - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Christian Fung - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Christopher Marvin Jesse - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Timo Miesbach - 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. DocV075

doi: 10.3205/18dgnc076, urn:nbn:de:0183-18dgnc0769

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) leaks cause spontaneous intracranial hypotension (SIH). Patients with long-standing SIH can develop chronic daily headaches without the typical orthostatic character. The aim of the study was to assess the parameters of CSF fluid dynamics in patients with chronic SIH and to compare them to patients presenting with acute SIH.

Methods: We included consecutive patients with proven SIH treated from January 2012 to August 2017. SIH 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. Patients were dichotomized into group A, presenting with acute symptoms of ≤10 weeks duration, and group B presenting with chronic symptoms of ≥52 weeks duration. Clinical characteristics and parameters of CSF fluid dynamics, which were obtained by computerized lumbar infusion testing, were compared between these groups.

Results: We performed a total of 115 computerized lumbar infusion tests in 111 patients. Of those, 26 presenting with acute SIH symptoms (group A) and 14 presenting with long-standing complaints (group B) fulfilled inclusion criteria. CSF Outflow Resistance (RCSF) in group A was 2.74mmHg/(ml/min) (95%-CI 2.01-3.47mmHg/(ml/min)) compared to 14.48mmHg/(ml/min) (95%-CI 8.02-20.94mmHg/(ml/min)) in group B (p=0.02). CSF Production rate and Pressure-Volume index were markedly increased in group A, while they were normal in group B (1.17ml/min versus 0.44ml/min, p=0.018, and 28.95ml versus 18.39ml, p<0.01). Mean opening pressure in group A was 4.61mmHg compared to 7.92mmHg in group B (p=0.017). Group A was more likely to present with typical orthostatic headache than group B (100% versus 64.3%, p=0.003).

Conclusion: In patients with chronic SIH the clinical picture changes and the typical orthostatic headache symptoms subside. Interestingly, we found that patients with acute symptoms and patients with chronic symptoms of SIH show completely different patterns of CSF fluid dynamics. Currently we can only speculate about any possible compensatory mechanisms.