Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension - a consecutive cohort study.

Fichtner, Jens; Ulrich, Christian Thomas; Fung, Christian; Cipriani, Debora Rosalba; Gralla, Jan; Piechowiak, Eike Immo; Schlachetzki, Felix; Z'Graggen, Werner Josef; Raabe, Andreas; Beck, Jürgen (2019). Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension - a consecutive cohort study. Cephalalgia, 39(2), pp. 306-315. Sage Publications 10.1177/0333102418793640

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Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (-0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Fichtner, Jens; Ulrich, Christian Thomas; Fung, Christian; Cipriani, Debora Rosalba; Gralla, Jan; Piechowiak, Eike Immo; Z'Graggen, Werner Josef; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0333-1024

Publisher:

Sage Publications

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

14 Aug 2018 13:55

Last Modified:

09 Feb 2019 01:31

Publisher DOI:

10.1177/0333102418793640

PubMed ID:

30099952

Uncontrolled Keywords:

Spontaneous intracranial hypotension gravitational challenge optic nerve sheath diameter orthostatic headaches spinal CSF leak spinal microsurgery transorbital sonography

URI:

https://boris.unibe.ch/id/eprint/119274

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