Repair of a ventral cervical cerebrospinal fluid leak via a single-level anterior cervical discectomy and fusion without corpectomy: illustrative case.

Abstract

Background: Spontaneous intracranial hypotension (SIH) is caused by CSF leakage through the skull base or, more commonly, the spine. In the spine, the CSF might leak into either the epidural space or a paraspinal vein in patients with a CSF-venous fistula. Nonoperative management, including caffeine, abdominal binders, oral fluids, and bed rest, is typically appropriate, although it yields unsatisfactory results for some patients.

Observations: The authors illustrate the surgical repair of a ventral, cervical CSF leak through a single-level anterior cervical discectomy and fusion (ACDF) without corpectomy in a 25-year-old patient with SIH. MRI and CT revealed a longitudinally extensive ventral epidural CSF collection and a calcified disc bulge at C5-6. Myelography showed no alternative source of leak. While a prior report describes repair via corpectomy, this article describes the technique for repair via ACDF only, with the use of a device designed for dural repair in minimally invasive spine surgery (DuraStat). This approach was particularly appealing in a young patient, and the dural defect was successfully repaired.

Lessons: The ability to perform repair of a ventral cervical CSF leak through a single-level ACDF might allow for the resolution of this challenging-to-treat condition while minimizing surgical morbidity. https://thejns.org/doi/10.3171/CASE24770.