Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension
Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension
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DOI：
10.3171/jns.1996.84.4.0598
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发表时间：
1996-04-01
影响因子：
4.1
通讯作者：
Mokri, B
中科院分区：
文献类型：
--
作者：
Schievink, WI;Meyer, FB;Mokri, B
脑脊液漏通常被认为是自发性低颅压综合征的原因，但很少有放射或手术证实。作者回顾了他们记录的11例自发性脑脊液漏患者的经验，包括其中4名患者的手术观察。纳入研究的6名女性和5名男性的平均年龄为35岁(范围22-51岁)。所有患者都表现为体位性头痛；然而，大多数患者还有其他症状，包括恶心、呕吐、第六颅神经麻痹或脑脊液渗漏水平的局部背痛。所有患者均接受了铟-111放射性核酸池造影或计算机断层扫描(CT)脊髓造影。自发性脑脊液漏位于颈椎2例，颈胸段3例，胸椎5例，腰椎1例。核素脑池造影术假阴性率高(30%)。硬膜下积液、脑膜强化和小脑下移，类似Chiari I型畸形，常见于头颅影像检查。在大多数患者中，症状在采取支持性措施或硬膜外补血后得到缓解。脑膜憩室漏是四名接受手术的患者脑脊液漏的原因。3名患者可以结扎这些憩室，效果良好，但1名患者发现广泛复杂的脑膜憩室不能手术。两名患者有不寻常的身体习性和关节过度活动度，另外两名患者在年轻时患有自发性视网膜脱离。总而言之，自发性脑脊液漏并不常见，但越来越多地被认为是自发性低颅压的原因。大多数脊液漏位于颈胸交界处或胸椎，可能与脑膜憩室有关。首选的放射学检查是CT脊髓造影术。这种疾病通常是自限性的，但在某些病例中，我们对漏水的脑膜憩室行手术结扎的经验令人满意。一些自发性脊液漏的患者可能存在潜在的结缔组织紊乱。
Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients.The mean age of the six women and five men included in the study was 35 years (range 22-51 years). All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak. All patients underwent indium-111 radionucleotide cisternography or computerized tomographic (CT) myelography. The location of the spontaneous CSF leak was in the cervical spine in two patients, the cervicothoracic junction in three patients, the thoracic spine in five patients, and the lumbar spine in one patient. The false negative rate for radionucleotide cisternography was high (30%). Subdural fluid collections, meningeal enhancement, and downward displacement of the cerebellum, resembling a Chiari I malformation, were commonly found on cranial imaging studies. In most patients, the symptoms resolved in response to supportive measures or an epidural blood patch. Leaking meningeal diverticula were found to be the cause of the CSF leak in four patients who underwent surgery. In three patients these diverticula could be ligated with good result but in one patient an extensive complex of meningeal diverticula was found to be inoperable. Two patients had an unusual body habitus and joint hypermobility, and two other patients had suffered a spontaneous retinal detachment at a young age.In conclusion, spontaneous spinal CSF leaks are uncommon, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most spinal CSF leaks are located at the cervicothoracic junction or in the thoracic spine, and they may be associated with meningeal diverticula. The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical Ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.