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Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension

Authors :
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
Source :
Neurology. 87:1220-1226
Publication Year :
2016
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2016.

Abstract

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.

Details

ISSN :
1526632X and 00283878
Volume :
87
Database :
OpenAIRE
Journal :
Neurology
Accession number :
edsair.doi.dedup.....081816c1455e0d2a04aa47c3f7aa2f46
Full Text :
https://doi.org/10.1212/wnl.0000000000003122