Symptomatic cerebral spinal fluid leak (or intracranial hypotension) due to sacral extradural cyst rupture after sacral fracture: illustrative case.

Background: Intracranial hypotension due to a CSF leak has many possible etiologies including traumatic dural tears, CSF-venous fistulas, iatrogenic causes, and elevated intracranial pressure. An example of traumatic rupture of a preexisting congenital spinal cyst (SC) in the sacrum causing a symptomatic CSF leak has not been described in the literature; therefore, the authors present the case of a 13-year-old female with a previously undiagnosed SC (Nabor type IB, sacral meningocele) found to have symptomatic intracranial hypotension following a ground-level fall.

Observations: Traumatic rupture of SCs may cause a dural tear, resulting in stigmata of intracranial hypotension.

Lessons: SCs are rare entities that are often asymptomatic but should be carefully considered in the differential diagnoses for intracranial hypotension, even following low-impact trauma. Symptoms resolve with definitive treatment of dural tear, and recurrence rates are low. https://thejns.org/doi/10.3171/CASE2555.