Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time.

Häni, Levin; Fung, Christian; Jesse, Christopher Marvin; Ulrich, Christian Thomas; Piechowiak, Eike Immo; Gralla, Jan; Raabe, Andreas; Dobrocky, Tomas; Beck, Jürgen (2022). Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time. Journal of neurology, 269(3), pp. 1439-1446. 10.1007/s00415-021-10710-7

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OBJECTIVE

Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH). Microsurgery can sufficiently seal spinal CSF leaks. Yet, some patients suffer from residual symptoms. Aim of the study was to assess predictors for favorable outcome after surgical treatment of SIH.

METHODS

We included consecutive patients with SIH treated surgically from January 2013 to May 2020. Subjects were surveyed by a questionnaire. Primary outcome was resolution of symptoms as rated by the patient. Secondary outcome was postoperative headache intensity on the numeric rating scale (NRS). Association between variables and outcome was assessed using univariate and multivariate regression. A cut-off value for continuous variables was calculated by a ROC analysis.

RESULTS

Sixty-nine out of 86 patients (80.2%) returned the questionnaire and were analyzed. Mean age was 46.7 years and 68.1% were female. A significant association with the primary and secondary outcome was found only for preoperative symptom duration (p = 0.001 and p < 0.001), whereby a shorter symptom duration was associated with a better outcome. Symptom duration remained a significant predictor in a multivariate model (p = 0.013). Neither sex, age, type of pathology, lumbar opening pressure, nor initial presentation were associated with the primary outcome. ROC analysis yielded treatment within 12 weeks as a cut-off for better outcome.

CONCLUSION

Shorter duration of preoperative symptoms is the most powerful predictor of favorable outcome after surgical treatment of SIH. While an initial attempt of conservative treatment is justified, we advocate early definitive treatment within 12 weeks in case of persisting symptoms.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Häni, Levin, Fung, Christian, Jesse, Christopher Marvin, Ulrich, Christian Thomas (A), Piechowiak, Eike Immo, Gralla, Jan, Raabe, Andreas, Dobrocky, Tomas, Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1432-1459

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

04 Oct 2021 14:57

Last Modified:

29 Mar 2023 23:37

Publisher DOI:

10.1007/s00415-021-10710-7

PubMed ID:

34274993

Uncontrolled Keywords:

Low ICP syndrome Orthostatic headache Spinal cerebrospinal fluid leak Spontaneous intracranial hypotension

BORIS DOI:

10.48350/159373

URI:

https://boris.unibe.ch/id/eprint/159373

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