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Related Experiment Videos

Intracranial hypotension.

A Matsumura, I Anno, T Nose

    Journal of Neurosurgery
    |November 13, 2001
    PubMed
    Summary
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    For intractable spontaneous intracranial hypotension, surgical intervention is more effective than prolonged conservative management. Upright radionuclide cisternography aids in identifying cerebrospinal fluid (CSF) leaks for targeted surgical repair.

    Area of Science:

    • Neurosurgery
    • Neurology
    • Radiology

    Background:

    • Spontaneous intracranial hypotension (SIH) can lead to debilitating symptoms and complications like chronic subdural hematomas.
    • Conservative management, including prolonged bed rest, is often the initial approach but may be ineffective for severe cases.

    Observation:

    • A 55-year-old male with intractable SIH failed conservative treatment, necessitating surgical intervention for bilateral chronic subdural hematomas.
    • Conventional imaging (MRI, CT myelography, radionuclide cisternography) failed to localize the cerebrospinal fluid (CSF) leak.
    • Positional radionuclide cisternography (upright) and dynamic CT myelography (breath-holding) successfully identified bilateral upper cervical CSF leaks.

    Findings:

    • Surgical sealing of bilateral C-2 and C-3 spinal nerve root pouches using oxidized cellulose cotton and fibrin glue successfully resolved the CSF leakage.

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  • The patient experienced complete resolution of SIH symptoms post-operatively.

    • Implications:

    • Surgical treatment should be considered for intractable spontaneous intracranial hypotension refractory to conservative measures.
    • Upright radionuclide cisternography is a valuable tool for diagnosing elusive CSF leaks in SIH.
    • Subarachnoid surgical sealing of identified CSF leak sites offers a definitive treatment option.