Inamasu Joji, Guiot Bernard H
Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL 33606, USA.
Spine J. 2006 Sep-Oct;6(5):591-9. doi: 10.1016/j.spinee.2005.12.026. Epub 2006 Jul 11.
Intracranial hypotension (IH) is a syndrome in which volume depletion of the cerebrospinal fluid (CSF) results in various neurological symptoms. Most commonly, a small tear or defect in the spinal dural sac is the underlying lesion that results in a CSF leakage and IH. Causes of IH can be classified as 1) spontaneous (primary), and 2) secondary. Knowledge of IH is essential to spine surgeons, because a small proportion of patients with spontaneous IH require spine surgery, and secondary causes of IH include spine trauma, various spine-related diagnostic/therapeutic procedures (iatrogenic), and degenerative spine disorders.
The purpose of this review is to update knowledge of IH pertinent to spine surgery.
STUDY DESIGN/SETTING: Review of the literature.
A systematic review of the literature was conducted using PUBMED. The literature regarding IH with spinal pathology published from 1966 to 2005 was searched and reviewed comprehensively.
RESULTS/CONCLUSIONS: The lower cervical and upper thoracic spine are the predilection sites for a CSF leak in patients with spontaneous IH. Mechanical stress may have a role in the pathogenesis of spontaneous IH, and meningeal diverticula and connective tissue disorders may be important risk factors. Iatrogenic causes of IH include lumbar puncture, spine surgery, and chiropractic manipulation. Rarely, degenerative spine disorders are the secondary cause of IH. Although orthostatic headache is the characteristic symptom of IH, a small proportion of patients present with neck pain or radicular symptoms of the upper extremity. Imaging studies of the spine have contributed significantly to elucidation of the pathophysiology of IH as well as identification of the site of a CSF leak. Typical spinal radiographic findings of IH include extra-arachnoid or extradural fluid collections, meningeal enhancement, engorgement of the epidural venous plexus, and tonsilar descent into the foramen magnum. Most patients with spontaneous IH respond favorably to conservative management, including autologous epidural blood patch. Surgical intervention is reserved for those who fail the conservative management. Although immediate clinical improvement is usually achieved by surgery, the long-term outcomes of surgical patients need to be investigated further. In patients who have a secondary cause of IH, treatment of the underlying lesion or condition may terminate a CSF leak and result in reversal of symptoms.
颅内低压（IH）是一种因脑脊液（CSF）容量减少而导致各种神经症状的综合征。最常见的情况是，脊髓硬脊膜囊出现小的撕裂或缺损是导致脑脊液漏和颅内低压的潜在病变。颅内低压的病因可分为1）自发性（原发性）和2）继发性。了解颅内低压对于脊柱外科医生至关重要，因为一小部分自发性颅内低压患者需要进行脊柱手术，而颅内低压的继发性病因包括脊柱创伤、各种与脊柱相关的诊断/治疗程序（医源性）以及脊柱退行性疾病。
本综述的目的是更新与脊柱手术相关的颅内低压知识。
研究设计/背景：文献综述。
使用PUBMED对文献进行系统综述。全面检索并回顾了1966年至2005年发表的有关伴有脊柱病变的颅内低压的文献。
结果/结论：下颈椎和上胸椎是自发性颅内低压患者脑脊液漏的好发部位。机械应力可能在自发性颅内低压的发病机制中起作用，脑膜憩室和结缔组织疾病可能是重要的危险因素。颅内低压的医源性病因包括腰椎穿刺、脊柱手术和整脊手法治疗。很少见的是，脊柱退行性疾病是颅内低压的继发性病因。虽然直立性头痛是颅内低压的特征性症状，但一小部分患者表现为颈部疼痛或上肢神经根症状。脊柱影像学研究对阐明颅内低压的病理生理学以及确定脑脊液漏的部位有很大帮助。颅内低压典型的脊柱影像学表现包括蛛网膜下腔或硬膜外积液、脑膜强化、硬膜外静脉丛充血以及扁桃体疝入枕骨大孔。大多数自发性颅内低压患者对保守治疗反应良好，包括自体硬膜外血贴。手术干预适用于保守治疗失败的患者。虽然手术通常能立即改善临床症状，但手术患者的长期预后需要进一步研究。对于有颅内低压继发性病因的患者，治疗潜在病变或疾病可能会终止脑脊液漏并导致症状逆转。
