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Spontaneous Spinal Cerebrospinal Fluid Leak: Review and Management Algorithm.

Michael R Jones1, Nathan A Shlobin1, Nader S Dahdaleh1

  • 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

World Neurosurgery
|April 2, 2021
PubMed
Summary

Spontaneous spinal cerebrospinal fluid (CSF) leaks cause severe headaches and may require advanced imaging and treatments like epidural patching or surgery when conservative methods fail. This review outlines current management strategies for this complex condition.

Keywords:
Cerebrospinal fluid leakCerebrospinal fluid venous fistulaOrthostatic headachePositional headacheSpontaneous intracranial hypotension

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Spontaneous spinal cerebrospinal fluid (CSF) leaks often manifest as debilitating positional headaches.
  • The spinal origin of the leak is common, but diagnosis and treatment can be challenging.

Purpose of the Study:

  • To review the current literature on spontaneous spinal CSF leaks.
  • To present a management algorithm for this condition.

Main Methods:

  • Literature review of diagnostic and therapeutic modalities for spinal CSF leaks.
  • Development of a clinical management algorithm.

Main Results:

  • Conservative management, such as epidural blood patching, is often effective but not universally successful.
  • Identifying the leak's focal location may necessitate multiple imaging techniques.
  • Treatment options include targeted patching and surgical closure.

Conclusions:

  • Spontaneous spinal CSF leaks present a diagnostic and therapeutic challenge.
  • A structured approach incorporating advanced imaging and tailored treatments is crucial for effective management.