Surgical Treatment of Spontaneous Intracranial Hypotension From Spinal Cerebrospinal Fluid Leak: Single Institution Case Series.

Background and objectives: Spontaneous intracranial hypotension (SIH) is a rare but debilitating condition caused by spontaneous spinal cerebrospinal fluid (CSF) leaks, resulting in low intracranial pressure. Patients with SIH often experience orthostatic headaches, nausea, dizziness, visual and auditory changes, and cognitive impairment. While initial treatment includes oral analgesics, rest, and epidural blood patching, refractory cases may require advanced diagnostics and surgical intervention to repair the CSF leak. The aim of this study was to review the characteristics and outcomes of patients with refractory SIH who underwent surgical repair for spontaneous spinal CSF leaks.

Methods: This retrospective, Institutional Review Board-approved (STUDY00007663), single-institution study reviewed patients with SIH because of spontaneous spinal CSF leaks who underwent surgery by a single surgeon from September 2022 to June 2024. Demographics, clinical symptoms, diagnostics, and outcomes were collected through chart review. Preoperative and postoperative Bern scores, derived from brain MRIs, were evaluated by a neuroradiologist.

Results: Among 138 patients diagnosed with SIH, 50 refractory to conservative management underwent surgical repair. The surgical cohort had an average age of 52.1 ± 13.9 years, with 64% female. Presenting symptoms included headaches (92%), pain/numbness (46%), and nausea/vomiting (46%). CSF leak classifications were Type I (38%), Type II (10%), and Type III (52%). Postsurgery, 96% achieved significant symptom resolution or improvement, with notable reductions in headache frequency (P < .01), Bern scores (P < .01), and Visual Analog Scale scores (P < .01).

Conclusion: Surgical repair is crucial for managing refractory SIH, with tailored techniques based on leak type and location. This study underscores the need for further research into the predictive utility of Bern scores in surgical outcomes across various CSF leak types.