Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Beck, Jürgen; Gralla, Jan; Fung, Christian; Ulrich, Christian T.; Schucht, Philippe; Fichtner, Jens; Andereggen, Lukas; Gosau, Martin; Hattingen, Elke; Gutbrod, Klemens; Z'Graggen, Werner Josef; Reinert, Michael; Hüsler, Jürg; Ozdoba, Christoph; Raabe, Andreas (2014). Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients. Journal of neurosurgery, 121(6), pp. 1380-1387. American Association of Neurological Surgeons 10.3171/2014.6.JNS14550

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OBJECT The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH. METHODS All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak. RESULTS Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings. CONCLUSIONS The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
08 Faculty of Science > Institute of Applied Physics
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
08 Faculty of Science > Department of Mathematics and Statistics > Institute of Mathematical Statistics and Actuarial Science
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
07 Faculty of Human Sciences > Institute of Psychology > Experimental Psychology and Neuropsychology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Mu50 > Forschungsgruppe Neurochirurgie

UniBE Contributor:

Beck, Jürgen; Gralla, Jan; Fung, Christian; Ulrich, Christian T.; Schucht, Philippe; Fichtner, Jens; Andereggen, Lukas; Gutbrod, Klemens; Z'Graggen, Werner Josef; Reinert, Michael; Hüsler, Jürg; Ozdoba, Christoph and Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health
600 Technology > 620 Engineering
100 Philosophy > 150 Psychology
300 Social sciences, sociology & anthropology > 360 Social problems & social services
500 Science > 510 Mathematics

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

06 Oct 2014 14:15

Last Modified:

09 Sep 2017 03:28

Publisher DOI:

10.3171/2014.6.JNS14550

PubMed ID:

25036203

BORIS DOI:

10.7892/boris.58235

URI:

https://boris.unibe.ch/id/eprint/58235

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