Chronic CSF leak from lumbar-peritoneal shunt tract: A case report

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Describes a case of chronic intracranial hypotension.
• Investigates an iatrogenic arachnoid diverticulum as the cause.
• Highlights learning points for managing CSF leaks.

Observation:

• A 55-year-old female with idiopathic intracranial hypertension presented with low-pressure symptoms post-lumboperitoneal shunt removal.
• MRI revealed Chiari I malformation and a dural defect.
• CT myelography confirmed a dural abnormality at L3/4.

Findings:

• Intraoperative findings included a dural defect with an arachnoid bleb and associated vascular and adipose tissue.
• Excessive cerebrospinal fluid (CSF) absorption occurred via an acquired arachnoid-epidural venous plexus.
• The patient experienced significant symptom resolution after surgical repair.

Implications:

• Suggests that acquired arachnoid-epidural venous plexuses can lead to excessive CSF absorption.
• Emphasizes the need for a high index of suspicion for intracranial hypotension in patients with low-pressure symptoms and Chiari I malformation.
• Supports definitive surgical repair as a beneficial treatment for long-standing CSF leaks.