Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension

Beck, Jürgen; Ulrich, Christian Thomas; Fung, Christian; Fichtner, Jens; Seidel, Kathleen; Fiechter, Michael; Hsieh, Kety Wha-Vei; Murek, Michael Konrad; Bervini, David; Meier, Niklaus; Mono, Marie-Luise; Mordasini, Pasquale; Hewer, Ekkehard; Z'Graggen, Werner Josef; Gralla, Jan; Raabe, Andreas (2016). Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension. Neurology, 87(12), pp. 1220-1226. Lippincott Williams & Wilkins 10.1212/WNL.0000000000003122

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OBJECTIVE To visualize and treat spinal dural CSF leaks in all patients with intractable spontaneous intracranial hypotension (SIH) who underwent spinal microsurgical exploration. METHODS Patients presenting between February 2013 and July 2015 were included in this consecutive case series. The workup included spinal MRI without and with intrathecal contrast, dynamic myelography, postmyelography CT, and microsurgical exploration. RESULTS Of 69 consecutive patients, 15 had intractable symptoms. Systematic imaging revealed a suspicious single location of the leak in these 15 patients. Fourteen patients underwent microsurgical exploration; 1 patient refused surgery. Intraoperatively, including intradural exploration, we identified the cause of the CSF leaks as a longitudinal dural slit (6.1 ± 1.7 mm) on the ventral (10), lateral (3), or dorsal (1) aspect of the dura. In 10 patients (71%), a ventral, calcified microspur originating from the intervertebral disk perforated the dura like a knife. Three patients (22%) had a lateral dural tear with an associated spinal meningeal diverticulum, and in 1 patient (7%), a dorsal osteophyte was causal. The microspurs were removed and the dural slits sutured with immediate cessation of CSF leakage. CONCLUSION The nature of the CSF leak is a circumscribed longitudinal slit at the ventral, lateral, or dorsal dura mater. An extradural pathology, diskogenic microspurs, was the single cause for all ventral CSF leaks. These findings challenge the notion that CSF leaks in SIH are idiopathic or due to a weak dura. Microsurgery is the treatment of choice in cases with intractable SIH.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute of Pathology > Clinical Pathology
04 Faculty of Medicine > Service Sector > Institute of Pathology
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
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Beck, Jürgen; Ulrich, Christian Thomas; Fung, Christian; Fichtner, Jens; Seidel, Kathleen; Fiechter, Michael; Hsieh, Kety Wha-Vei; Murek, Michael Konrad; Bervini, David; Meier, Niklaus; Mono, Marie-Luise; Mordasini, Pasquale; Hewer, Ekkehard; Z'Graggen, Werner Josef; Gralla, Jan and Raabe, Andreas

Subjects:

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

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

13 Sep 2016 13:44

Last Modified:

27 Apr 2017 16:02

Publisher DOI:

10.1212/WNL.0000000000003122

PubMed ID:

27566748

BORIS DOI:

10.7892/boris.87519

URI:

https://boris.unibe.ch/id/eprint/87519

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