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Surgical Exploration of Radiographically Resolved Spontaneous Ventral Spinal CSF Leaks.

Wouter I Schievink1, Marcel M Maya2, Franklin G Moser2

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Summary

Exploratory surgery for spinal cerebrospinal fluid (CSF) leaks may benefit patients with persistent spontaneous intracranial hypotension (SIH) symptoms, even after radiographic healing.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Spontaneous intracranial hypotension (SIH) can persist despite radiographic resolution of spinal cerebrospinal fluid (CSF) leaks.
  • Identifying the cause of persistent SIH symptoms is crucial for effective treatment.

Purpose of the Study:

  • To report indications, intraoperative findings, and outcomes of exploratory surgery for radiographically resolved spontaneous ventral spinal CSF leaks.
  • To evaluate the efficacy of surgical intervention in selected SIH patients with persistent symptoms.

Main Methods:

  • A single-center review of a prospectively maintained database.
  • Inclusion of consecutive patients undergoing surgical exploration for radiographically resolved spontaneous ventral spinal CSF leaks.
  • Pre- and postoperative assessment using the spontaneous intracranial hypotension disability assessment score (SIHDAS).

Main Results:

  • Eight patients (mean age 45.9 years) with persistent SIH symptoms were identified.
  • Surgical exploration identified healed dural defects in 7 patients, which were repaired.
  • Postoperative improvement was reported in 6 patients, with SIHDAS scores improving from moderate/severe to mild/no disability.

Conclusions:

  • Surgical exploration may be considered in highly selected patients with persistent SIH symptoms and radiographically resolved spinal CSF leaks.
  • Targeting suspicious calcific lesions or previously identified leak sites is key for surgical exploration.