Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

Wouter I. Schievink, Vittorio M. Morreale, John L.D. Atkinson, Fredric B. Meyer, David G. Piepgras, Michael J. Ebersold

Research output: Contribution to journalArticle

189 Scopus citations

Abstract

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22-61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment considered of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3-58 months; 16 person-years of cumulative follow-up). Complication consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Original languageEnglish (US)
Pages (from-to)243-246
Number of pages4
JournalJournal of neurosurgery
Volume88
Issue number2
DOIs
StatePublished - Feb 1998

Keywords

  • Cerebrospinal fluid leak
  • Headache
  • Intracranial hypotension
  • Intracranial pressure

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Schievink, W. I., Morreale, V. M., Atkinson, J. L. D., Meyer, F. B., Piepgras, D. G., & Ebersold, M. J. (1998). Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. Journal of neurosurgery, 88(2), 243-246. https://doi.org/10.3171/jns.1998.88.2.0243