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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Predicting spinal CSF leaks in intracranial hypotension – a scoring system based on brain MRI findings

Diagnostischer Score basierend auf MR-Bildern des Neurokraniums zur Beurteilung der Wahrscheinlichkeit des Vorliegens eines spinalen Liquorlecks bei Patienten mit spontaner intrakranieller Hypotension

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  • presenting/speaker Tomas Dobrocky - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Philipe Breiding - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Lorenz Grunder - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Pascal Mosimann - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Pasquale Mordasini - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Christian Fung - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Andreas Raabe - Inselspital, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Christian Ulrich - Inselspital, Universitätsklinik für Neurochirurgie, Bern, Switzerland
  • Jan Gralla - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Eike Immo Piechowiak - Inselspital, Institut für diagnostische und interventionelle Neuroradiologie, Bern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV047

doi: 10.3205/19dgnc059, urn:nbn:de:0183-19dgnc0591

Published: May 8, 2019

© 2019 Dobrocky 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

Text

Objective: Various signs may be observed on brain magnetic resonance imaging (MRI) in patients with spontaneous intracranial hypotension (SIH). However, the lack of a classification system integrating these findings limits decision making in clinical practice. The objective was to assess the likelihood of an underlying spinal CSF leak based on a probability score taking into account the most relevant brain MRI findings.

Methods: Three blinded readers retrospectively reviewed the brain MRI of 56 SIH patients with a proven spinal CSF leak and 60 healthy controls, evaluating seven quantitative and nine qualitative signs. We then derived a predictive diagnostic score based on multivariable backward logistic regression analysis. Its performance was further validated internally in a prospective cohort of 20 patients presenting with clinical signs of SIH.

Results: Six imaging findings were included in the final scoring system. Three were weighted as major (2 points): pachymeningeal enhancement, engorgement of venous sinus, effacement of the suprasellar cistern <4.0 mm. The three other criteria were considered minor (1 point): subdural fluid collection, effacement of the prepontine cistern <5·0 mm and mamillopontine distance <6·5 mm. Patients were then classified into low, intermediate or high probability of having a spinal CSF leak if the total score was <2, 3–4 or >5, respectively. The discriminatory ability of the proposed score could be demonstrated in the validation cohort.

Conclusion: The three-tier predictive scoring system we propose is based on the six most relevant brain MRI findings and allows to assess the likelihood (low, intermediate or high probability) of finding a spinal CSF leak in SIH patients. It may be useful in triaging patients who may or may not benefit from further invasive myelographic examinations before considering targeted therapy.

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