Document Detail

Surgical treatment of spontaneous intracranial hypotension secondary to degenerative cervical spine pathology: a case report and literature review.
MedLine Citation:
PMID:  21874294     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: A rare cause of intracranial hypotension is leakage of cerebrospinal fluid (CSF) through a dural breach from degenerative cervical spine pathology. To our knowledge there have been only four cases described in the English literature. Treatment is challenging and varies from case to case, with complete symptom resolution reported for only one patient. Herein we review the literature and describe our surgical management of a 46-year-old woman with symptomatic intracranial hypotension from the penetration of the cervical thecal sac.
CLINICAL PRESENTATION: The patient presented with a 3-month history of progressive orthostatic headaches. Magnetic resonance imaging demonstrated bilateral subdural hematomas and pachymeningeal gadolinium enhancement. An anterior epidural CSF collection commencing at a C4-5 calcified disc protrusion and osteophyte was evident on a computed tomography spinal myelogram.
INTERVENTION: After three unsuccessful lumbar blood patches, we elected to attempt surgical removal of the causative pathology with exposure and primary closure of the dural defect by anterior cervical discectomy as described previously. After resection of the disc-osteophyte complex and dural exposure, immediate high volume egression of CSF mixed with blood at the surgical site. The dural defect was not visible but CSF egression promptly ceased. Cervical corpectomy for greater exposure and primary repair of the defect has been described, but we considered this unwarranted and felt the intraoperative blood collection formed a local blood patch. A collagen dural substitute membrane was inserted through the discectomy space for reinforcement.
CONCLUSION: Two months after this novel surgical blood patch procedure the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
Christopher D Witiw; Aria Fallah; Paul J Muller; Howard J Ginsberg
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2011-08-27
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  21 Suppl 4     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-10-25     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  S422-7     Citation Subset:  IM    
School of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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MeSH Terms
Blood Patch, Epidural
Cervical Vertebrae / pathology,  surgery
Headache / etiology,  pathology,  surgery
Intervertebral Disc Degeneration / complications*,  pathology,  surgery
Intracranial Hypotension / etiology,  pathology,  surgery*
Middle Aged
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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