Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Neurologia i Neurochirurgia Polska
MENU
Shortcuts Submit an article Guide for Authors Special collections Ahead Of Print Reviewers 2023

open access

Vol 57, No 2 (2023)
Review Article
Submitted: 2022-05-31
Accepted: 2022-10-21
Published online: 2022-12-13
View PDF Download PDF file View HTML
Get Citation

Surgical management of spontaneous intracranial hypotension syndrome: a literature review

Paweł Sobczyk1, Piotr Bojarski1, Michał Sobstyl1
DOI: 10.5603/PJNNS.a2022.0076
·
Pubmed: 36511484
·
Neurol Neurochir Pol 2023;57(2):151-159.
Affiliations
  1. Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland

open access

Vol 57, No 2 (2023)
Review articles
Submitted: 2022-05-31
Accepted: 2022-10-21
Published online: 2022-12-13

Abstract

Introduction. Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The optimal management options for patients with SIH remain uncertain. The aim of this study was to review studies reporting the management of SIH with a special emphasis on the surgical treatment of SIH including clinical trials, case series and case reports related to the issue of various neurosurgical procedures performed for SIH treatment.

Objective. The clinical outcomes of patients diagnosed with SIH treated with either only surgery or with surgery as the primary method of treatment were analysed.

Material and methods. The PubMed, Scopus and Google Scholar databases were searched according to the established criteria.

Results. The literature search revealed seven clinical trials, five case series and eight case reports regarding surgical treatment of patients diagnosed with SIH. Manuscripts reporting at least five individuals treated surgically for SIH were considered as case series. In most published articles, surgery provided clinical benefit, resulting in a success rate of 82.6-100% for complete relief of SIH symptoms.

Conclusions. Our literature review has revealed that SIH can be diagnosed reliably by MRI and cisternography. The identification of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent. of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent.

Abstract

Introduction. Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The optimal management options for patients with SIH remain uncertain. The aim of this study was to review studies reporting the management of SIH with a special emphasis on the surgical treatment of SIH including clinical trials, case series and case reports related to the issue of various neurosurgical procedures performed for SIH treatment.

Objective. The clinical outcomes of patients diagnosed with SIH treated with either only surgery or with surgery as the primary method of treatment were analysed.

Material and methods. The PubMed, Scopus and Google Scholar databases were searched according to the established criteria.

Results. The literature search revealed seven clinical trials, five case series and eight case reports regarding surgical treatment of patients diagnosed with SIH. Manuscripts reporting at least five individuals treated surgically for SIH were considered as case series. In most published articles, surgery provided clinical benefit, resulting in a success rate of 82.6-100% for complete relief of SIH symptoms.

Conclusions. Our literature review has revealed that SIH can be diagnosed reliably by MRI and cisternography. The identification of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent. of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent.

Full Text:

View PDF Download PDF file View HTML
Get Citation

Keywords

spontaneous intracranial hypotension, surgery for spontaneous intracranial hypotension, cerebrospinal fluid leak, orthostatic headache

About this article
Title

Surgical management of spontaneous intracranial hypotension syndrome: a literature review

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 57, No 2 (2023)

Article type

Review Article

Pages

151-159

Published online

2022-12-13

Page views

2252

Article views/downloads

758

DOI

10.5603/PJNNS.a2022.0076

Pubmed

36511484

Bibliographic record

Neurol Neurochir Pol 2023;57(2):151-159.

Keywords

spontaneous intracranial hypotension
surgery for spontaneous intracranial hypotension
cerebrospinal fluid leak
orthostatic headache

Authors

Paweł Sobczyk
Piotr Bojarski
Michał Sobstyl

References (67)
  1. Schievink WI, Maya MM, Jean-Pierre S, et al. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol. 2008; 29(5): 853–856.
    CrossRefPubMed
  2. Upadhyaya P, Ailani J. A review of spontaneous intracranial hypotension. Curr Neurol Neurosci Rep. 2019; 19(5): 22.
    CrossRefPubMed
  3. D'Antona L, Jaime Merchan MA, Vassiliou A, et al. Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis. JAMA Neurol. 2021; 78(3): 329–337.
    CrossRefPubMed
  4. Tyree TL, Porter R. Spontaneous intracranial hypotension: a case study. J Am Acad Nurse Pract. 2012; 24(5): 286–289.
    CrossRefPubMed
  5. Wang TY, Karikari IO, Amrhein TJ, et al. Clinical outcomes following surgical ligation of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension: a prospective case series. Oper Neurosurg (Hagerstown). 2020; 18(3): 239–245.
    CrossRefPubMed
  6. Wang D, Sharma M. The state of spontaneous intracranial hypotension in 2020: A mini-review. Journal of Neurology & Neuromedicine. 2020; 5(4): 1–5.
    CrossRef
  7. Ferrante E, Rubino F, Beretta F, et al. Treatment and outcome of subdural hematoma in patients with spontaneous intracranial hypotension: a report of 35 cases. Acta Neurol Belg. 2018; 118(1): 61–70.
    CrossRefPubMed
  8. Schievink WI, Gordon OK, Tourje J. Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. Neurosurgery. 2004; 54(1): 65–70; discussion 70.
    CrossRefPubMed
  9. Reinstein E, Pariani M, Bannykh S, et al. Connective tissue spectrum abnormalities associated with spontaneous cerebrospinal fluid leaks: a prospective study. Eur J Hum Genet. 2013; 21(4): 386–390.
    CrossRefPubMed
  10. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006; 295(19): 2286–2296.
    CrossRefPubMed
  11. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia. 2008; 28(12): 1345–1356.
    CrossRefPubMed
  12. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1): 1–211.
    CrossRefPubMed
  13. Schievink WI, Deline CR. Headache secondary to intracranial hypotension. Curr Pain Headache Rep. 2014; 18(11): 457.
    CrossRefPubMed
  14. Schievink WI. Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol. 2003; 60(12): 1713–1718.
    CrossRefPubMed
  15. Schievink WI, Meyer FB, Atkinson JL, et al. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg. 1996; 84(4): 598–605.
    CrossRefPubMed
  16. Mokri B, Piepgras DG, Miller GM. Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement. Mayo Clin Proc. 1997; 72(5): 400–413.
    CrossRefPubMed
  17. Horton JC, Fishman RA. Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology. 1994; 101(2): 244–251.
    CrossRefPubMed
  18. Ferrante E, Savino A, Brioschi A, et al. Transient oculomotor cranial nerves palsy in spontaneous intracranial hypotension. J Neurosurg Sci. 1998; 42(3): 177–9; discussion 180.
    PubMed
  19. Warner GTA. Spontaneous intracranial hypotension causing a partial third cranial nerve palsy: a novel observation. Cephalalgia. 2002; 22(10): 822–823.
    CrossRefPubMed
  20. Brady-McCreery KM, Speidel S, Hussein MAW, et al. Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies. Binocul Vis Strabismus Q. 2002; 17(1): 43–48.
    PubMed
  21. Yamamoto M, Suehiro T, Nakata H, et al. Primary low cerebrospinal fluid pressure syndrome associated with galactorrhea. Intern Med. 1993; 32(3): 228–231.
    CrossRefPubMed
  22. Pakiam AS, Lee C, Lang AE. Intracranial hypotension with parkinsonism, ataxia, and bulbar weakness. Arch Neurol. 1999; 56(7): 869–872.
    CrossRefPubMed
  23. Ferrante E, Regna-Gladin C, Arpino I, et al. Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with spontaneous intracranial hypotension. Clin Neurol Neurosurg. 2013; 115(11): 2324–2328.
    CrossRefPubMed
  24. Chan SM, Chodakiewitz YG, Maya MM, et al. Intracranial hypotension and cerebrospinal fluid leak. Neuroimaging Clin N Am. 2019; 29(2): 213–226.
    CrossRefPubMed
  25. Hyun SH, Lee KH, Lee SuJ, et al. Potential value of radionuclide cisternography in diagnosis and management planning of spontaneous intracranial hypotension. Clin Neurol Neurosurg. 2008; 110(7): 657–661.
    CrossRefPubMed
  26. Davenport RJ, Chataway SJ, Warlow CP. Spontaneous intracranial hypotension from a CSF leak in a patient with Marfan's syndrome. J Neurol Neurosurg Psychiatry. 1995; 59(5): 516–519.
    CrossRefPubMed
  27. Beck J, Raabe A, Schievink WI, et al. Posterior approach and spinal cord release for 360° repair of dural defects in spontaneous intracranial hypotension. Neurosurgery. 2019; 84(6): E345–E351.
    CrossRefPubMed
  28. Thömke F, Bredel-Geißler A, Mika-Grüttner A, et al. Spontanes Liquorunterdrucksyndrom. Der Nervenarzt. 1999; 70(10): 909–915.
    CrossRef
  29. Maher CO, Meyer FB, Mokri B. Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. Neurosurg Focus. 2000; 9(1): e7.
    CrossRefPubMed
  30. Forghani R, Farb RI. Diagnosis and temporal evolution of signs of intracranial hypotension on MRI of the brain. Neuroradiology. 2008; 50(12): 1025–1034.
    CrossRefPubMed
  31. Sainani NI, Lawande MA, Pungavkar SA, et al. Spontaneous intracranial hypotension: a study of six cases with MR findings and literature review. Australas Radiol. 2006; 50(5): 419–423.
    CrossRefPubMed
  32. Kranz PG, Amrhein TJ, Choudhury KR, et al. Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016; 207(6): 1283–1287.
    CrossRefPubMed
  33. Michali-Stolarska M, Bladowska J, Stolarski M, et al. Diagnostic imaging and clinical features of intracranial hypotension - review of literature. Pol J Radiol. 2017; 82: 842–849.
    CrossRefPubMed
  34. Savoiardo M, Minati L, Farina L, et al. Spontaneous intracranial hypotension with deep brain swelling. Brain. 2007; 130(Pt 7): 1884–1893.
    CrossRefPubMed
  35. Graff-Radford SB, Schievink WI. High-pressure headaches, low-pressure syndromes, and CSF leaks: diagnosis and management. Headache. 2014; 54(2): 394–401.
    CrossRefPubMed
  36. Kranz PG, Luetmer PH, Diehn FE, et al. Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016; 206(1): 8–19.
    CrossRefPubMed
  37. Chazen JL, Talbott JF, Lantos JE, et al. MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2014; 35(10): 2007–2012.
    CrossRefPubMed
  38. Akbar JJ, Luetmer PH, Schwartz KM, et al. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2012; 33(3): 535–540.
    CrossRefPubMed
  39. Schievink WI, Moser FG, Maya MM. CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 2014; 83(5): 472–473.
    CrossRefPubMed
  40. Kranz PG, Amrhein TJ, Schievink WI, et al. The "hyperdense paraspinal vein" sign: marker of CSF-venous fistula. AJNR Am J Neuroradiol. 2016; 37(7): 1379–1381.
    CrossRefPubMed
  41. Schievink WI. Novel neuroimaging modalities in the evaluation of spontaneous cerebrospinal fluid leaks. Curr Neurol Neurosci Rep. 2013; 13(7): 358.
    CrossRefPubMed
  42. Schievink WI, Maya MM, Moser FG. Digital subtraction myelography in the investigation of post-dural puncture headache in 27 patients: technical note. J Neurosurg Spine. 2017; 26(6): 760–764.
    CrossRefPubMed
  43. Schievink WI, Morreale VM, Atkinson JL, et al. Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg. 1998; 88(2): 243–246.
    CrossRefPubMed
  44. Schievink WI, Reimer R, Folger WN. Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. Case report. J Neurosurg. 1994; 80(4): 736–739.
    CrossRefPubMed
  45. Schievink WI, Maya MM, Riedinger M. Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. J Neurosurg. 2003; 99(5): 840–842.
    CrossRefPubMed
  46. Vishteh AG, Schievink WI, Baskin JJ, et al. Cervical bone spur presenting with spontaneous intracranial hypotension. Case report. J Neurosurg. 1998; 89(3): 483–484.
    CrossRefPubMed
  47. Farhat HI, Hood B, Vanni S, et al. Minimally invasive repair of spontaneous intracranial hypotension. J Neurosurg. 2011; 114(2): 505–509.
    CrossRefPubMed
  48. Sobczyk P, Bojarski P, Sobstyl M. Surgical treatment of spontaneous intracranial hypotension syndrome secondary to the cervical cerebrospinal leak - a case report. Pol Merkur Lekarski. 2022; 50: 40–43.
  49. Inamasu J, Nakamura Y, Orii M, et al. Treatment of spontaneous intracranial hypotension secondary to C-2 meningeal cyst by surgical packing--case report. Neurol Med Chir (Tokyo). 2004; 44(6): 326–330.
    CrossRefPubMed
  50. Pricola Fehnel K, Borges LF. Posterior thoracic laminoplasty with dorsal, intradural identification of ventral defect and transdural discectomy for a spontaneous cerebrospinal fluid leak: case report. J Neurosurg Spine. 2015; 22(5): 478–482.
    CrossRefPubMed
  51. Kamenova M, Schaeren S, Wasner MG. Intradural extraarachnoid sutureless technique combined with laminoplasty for indirect repair of ventral dural defects in spontaneous intracranial hypotension: technical note and case series. Acta Neurochir (Wien). 2021; 163(9): 2551–2556.
    CrossRefPubMed
  52. Turel MK, Kerolus MG, O'Toole JE. Ossified ligamentum flavum of the thoracic spine presenting as spontaneous intracranial hypotension: case report. J Neurosurg Spine. 2018; 28(4): 401–405.
    CrossRefPubMed
  53. Shahab S, Soliman MAR, Alkhamees AF, et al. Surgical intervention for spontaneous intracranial hypotension Type 4 CSF leak: A case report. Surg Neurol Int. 2020; 11: 421.
    CrossRefPubMed
  54. Häni L, Fung C, Jesse CM, et al. Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time. J Neurol. 2022; 269(3): 1439–1446.
    CrossRefPubMed
  55. Kantor D, Silberstein SD. Cervical epidural blood patch for low CSF pressure headaches. Neurology. 2005; 65(7): 1138.
    CrossRefPubMed
  56. Eross EJ, Dodick DW, Nelson KD, et al. Orthostatic headache syndrome with CSF leak secondary to bony pathology of the cervical spine. Cephalalgia. 2002; 22(6): 439–443.
    CrossRefPubMed
  57. Witiw CD, Fallah A, Muller PJ, et al. Surgical treatment of spontaneous intracranial hypotension secondary to degenerative cervical spine pathology: a case report and literature review. Eur Spine J. 2012; 21 Suppl 4: S422–S427.
    CrossRefPubMed
  58. Chai CM, Banu MA, Cobb W, et al. Novel hydrogel application in minimally invasive surgical approaches to spontaneous intracranial hypotension. Report of 2 cases. J Neurosurg. 2014; 121(4): 976–982.
    CrossRefPubMed
  59. Majeed K, Hanz SZ, Roytman M, et al. Identification and surgical ligation of spinal CSF-venous fistula. Surg Neurol Int. 2021; 12: 514.
    CrossRefPubMed
  60. Idrissi AL, Lacour JC, Klein O, et al. Spontaneous Intracranial Hypotension: Characteristics of the Serious Form in a Series of 24 Patients. World Neurosurg. 2015; 84(6): 1613–1620.
    CrossRefPubMed
  61. Urbach H, Fung C, Dovi-Akue P, et al. Spontaneous intracranial hypotension. Dtsch Arztebl Int. 2020; 117(27-28): 480–487.
    CrossRefPubMed
  62. Schwedt TJ, Dodick DW. Spontaneous intracranial hypotension. Curr Pain Headache Rep. 2007; 11(1): 56–61.
    CrossRefPubMed
  63. Dillon WP. Challenges in the diagnosis and treatment of spontaneous intracranial hypotension. Radiology. 2018; 289(3): 773–774.
    CrossRefPubMed
  64. Martin R, Louy C, Babu V, et al. A two-level large-volume epidural blood patch protocol for spontaneous intracranial hypotension: retrospective analysis of risk and benefit. Reg Anesth Pain Med. 2019 [Epub ahead of print].
    CrossRefPubMed
  65. Tonnelet R, Colnat-Coulbois S, Mione G, et al. Successful treatment of spontaneous intracranial hypotension by plugging the cerebrospinal fluid leak with percutaneous cyanoacrylate injection: A report of 2 cases. World Neurosurg. 2016; 91: 390–398.
    CrossRefPubMed
  66. Berroir S, Grabli D, Héran F, et al. Cerebral sinus venous thrombosis in two patients with spontaneous intracranial hypotension. Cerebrovasc Dis. 2004; 17(1): 9–12.
    CrossRefPubMed
  67. Beck J, Ulrich CT, Fung C, et al. Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension. Neurology. 2016; 87(12): 1220–1226.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl