Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension
| Autor: | Marie-Luise Mono, Kety Hsieh, David Bervini, Michael Fiechter, Kathleen Seidel, Christian Fung, Jürgen Beck, Werner J. Z’Graggen, Jens Fichtner, Niklaus Meier, Michael Murek, Jan Gralla, Ekkehard Hewer, Andreas Raabe, Pasquale Mordasini, Christian T. Ulrich |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Microsurgery medicine.medical_specialty Dura mater medicine.medical_treatment Intracranial Hypotension Neurosurgical Procedures 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Humans Medicine 610 Medicine & health Cerebrospinal Fluid Leak medicine.diagnostic_test Cerebrospinal fluid leak business.industry Osteophyte Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Surgery Intervertebral disk Treatment Outcome medicine.anatomical_structure 570 Life sciences biology Female Spinal Diseases Neurology (clinical) Spinal meningeal diverticulum Tomography X-Ray Computed business Myelography Algorithms 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurology. 87:1220-1226 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000003122 |
| Popis: | Objective: To visualize and treat spinal dural CSF leaks in all patients with intractable spontaneous intracranial hypotension (SIH) who underwent spinal microsurgical exploration. Methods: Patients presenting between February 2013 and July 2015 were included in this consecutive case series. The workup included spinal MRI without and with intrathecal contrast, dynamic myelography, postmyelography CT, and microsurgical exploration. Results: Of 69 consecutive patients, 15 had intractable symptoms. Systematic imaging revealed a suspicious single location of the leak in these 15 patients. Fourteen patients underwent microsurgical exploration; 1 patient refused surgery. Intraoperatively, including intradural exploration, we identified the cause of the CSF leaks as a longitudinal dural slit (6.1 ± 1.7 mm) on the ventral (10), lateral (3), or dorsal (1) aspect of the dura. In 10 patients (71%), a ventral, calcified microspur originating from the intervertebral disk perforated the dura like a knife. Three patients (22%) had a lateral dural tear with an associated spinal meningeal diverticulum, and in 1 patient (7%), a dorsal osteophyte was causal. The microspurs were removed and the dural slits sutured with immediate cessation of CSF leakage. Conclusion: The nature of the CSF leak is a circumscribed longitudinal slit at the ventral, lateral, or dorsal dura mater. An extradural pathology, diskogenic microspurs, was the single cause for all ventral CSF leaks. These findings challenge the notion that CSF leaks in SIH are idiopathic or due to a weak dura. Microsurgery is the treatment of choice in cases with intractable SIH. |
| Databáze: | OpenAIRE |
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