Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension.

Dobrocky, T.; Rebsamen, M.; Rummel, C.; Häni, L.; Mordasini, P.; Raabe, A.; Ulrich, C. T.; Gralla, J.; Piechowiak, E. I.; Beck, J. (2020). Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension. AJNR. American journal of neuroradiology, 41(11), pp. 2055-2061. American Society of Neuroradiology 10.3174/ajnr.A6782

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BACKGROUND AND PURPOSE

CSF loss in spontaneous intracranial hypotension disrupts a well-regulated equilibrium. We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach.

MATERIALS AND METHODS

In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.

RESULTS

Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL; P < .001). The change was apparent in the early follow-up (mean, 4 days). No significant change in mean total brain volume was observed (1136.9 versus 1133.1 mL, P = .58). The mean spontaneous intracranial hypotension score decreased from 6.9  ± 1.5 at baseline to 2.9 ± 1.5 postoperatively.

CONCLUSIONS

Our study demonstrated a substantial increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.

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:

Dobrocky, Tomas; Rebsamen, Michael Andreas; Rummel, Christian; Häni, Levin; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Gralla, Jan; Piechowiak, Eike Immo and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1936-959X

Publisher:

American Society of Neuroradiology

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

11 Dec 2020 16:45

Last Modified:

11 Dec 2020 16:48

Publisher DOI:

10.3174/ajnr.A6782

PubMed ID:

33177057

BORIS DOI:

10.7892/boris.148206

URI:

https://boris.unibe.ch/id/eprint/148206

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