Spinal CSF leaks in spontaneous intracranial hypotension: A single-institution analysis of incidence, typology and treatment outcomes

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-23 DOI:10.1016/j.clineuro.2025.108978

Bala McRae-Posani , Andrew Kim , David Edasery , Sara Strauss , Michelle Roytman , John K. Park , Gayle Salama

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引用次数: 0

Abstract

Objective

To report incidence, typology and treatment outcomes of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH).

Methods

In this IRB approved study, consecutive SIH patients with myelogram-confirmed spinal CSF leak location, who underwent treatment between 2021 and 2023 at a single institution were retrospectively analyzed. The outcome variable was definitive treatment of SIH, defined as clinical and/or radiographic resolution of symptoms. Leak type classification was: Type 1 = ventral dural tear, Type 2 = lateral dural nerve root sleeve tear, Type 3 = CSF-venous fistula (CVF).

Results

32 SIH patients (average age 48 ± 15, 28 % male, 72 % female) were analyzed. A majority of them had a Type 1 CSF leak (59 %), followed by Type 3 (31 %) and Type 2 (9 %) leaks. Thoracic spine was the predominant location of the leaks (84 %); notably all CSF-venous fistulas were located there. Following trials of conservative management, all patients underwent treatment with EBP after leak site localization. 22/32 patients (69 %) had at least some resolution of symptoms following the first EBP. For 2/32 (6 %, both Type 2 leak), one targeted EBP provided definitive treatment. 30/32 (94 %, all leak types) had persistent clinical symptoms and had additional EBP(s). The mean number of EBPs per patient was 1.4 (range = 1–3). Following treatment failure of EBP(s), 10 patients with Type 3 leaks had transvenous embolization, which resulted in definitive treatment for 9 (90 %); 16 patients (leak Type 1 = 15, Type 2 = 1) had open dural surgery, which resulted in definitive treatment for 15 (94 %, all Type 1 leaks).

Conclusion

Overall, our analysis is consistent with recent data demonstrating that SIH incidence is higher among female patients and that CVFs are slightly more prevalent than previously reported, seen in nearly a third of our patients. Thoracic spine is the predominant location of CSF leaks; all our CVFs were located there. On treatment modalities, while EBP remains an important tool offering immediate symptom relief to SIH patients in the short term, permanent closure of the CSF leak and complete resolution of symptoms is rarely achieved with EBP. Definitive treatment is more likely with targeted endovascular and surgical modalities.

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自发性颅内低血压中脊髓脊液泄漏：发生率、类型和治疗结果的单机构分析

目的报道自发性颅内低血压（SIH）患者脊髓脊液渗漏的发生率、分型及治疗结果。方法在这项经IRB批准的研究中，回顾性分析了在2021年至2023年期间在单一机构接受治疗的脊髓造影确认的脊髓脊液泄漏位置的连续SIH患者。结果变量是SIH的最终治疗，定义为临床和/或影像学症状的缓解。漏型分型为：1型 = 硬膜腹侧撕裂，2型 = 硬膜外侧神经根袖撕裂，3型 = csf -静脉瘘（CVF）。结果本组共32例SIH患者（平均年龄48岁 ± 15例，男性28 %，女性72 %）。大多数患者为1型脑脊液渗漏（59 %），其次为3型（31 %）和2型（9 %）渗漏。胸椎是渗漏的主要部位（84% %）；值得注意的是，所有csf静脉瘘均位于此处。在保守治疗试验之后，所有患者在泄漏部位定位后都接受了EBP治疗。22/32例患者（69 %）在首次EBP治疗后症状至少有所缓解。对于2/32（6 %，均为2型泄漏），一个靶向EBP提供了明确的治疗。30/32（94 %，所有泄漏类型）有持续的临床症状，并有额外的EBP。每位患者的平均ebp数为1.4（范围= 1-3）。EBP治疗失败后，10例3型泄漏患者经静脉栓塞，最终治疗9例（90% %）；16例患者（1型渗漏 = 15,2型渗漏 = 1）行开放硬膜手术，最终15例（94 %，全部为1型渗漏）得到明确治疗。总的来说，我们的分析与最近的数据一致，表明SIH在女性患者中的发病率更高，而CVFs比之前报道的略高，在近三分之一的患者中可见。胸椎是脑脊液渗漏的主要部位；我们所有的cvf都在那里。在治疗方式上，虽然EBP仍然是一种重要的工具，可以在短期内立即缓解SIH患者的症状，但EBP很少能永久关闭脑脊液泄漏并完全解决症状。明确的治疗更可能是有针对性的血管内和手术方式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.