Yoon Sang Hoon, Chung Young Seob, Yoon Byung-Woo, Kim Jung-Eun, Paek Sun-Ha, Kim Dong-Gyu
Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Clin Neurol Neurosurg. 2011 Jun;113(5):373-9. doi: 10.1016/j.clineuro.2010.12.015. Epub 2011 Feb 2.
We analyzed our clinical experience with patients with intracranial hypotension and developed a strategic model for the diagnosis mainly using Radioisotope (RI) cisternography and treatment of spontaneous intracranial hypotension (SIH).
We retrospectively analyzed our clinical experiences with 30 cases of SIH from January 2000 through December 2006. All patients had confirmed by magnetic resonance image (MRI). RI cisternography or computed-tomography (CT) myelography was done for disclosing a cerebrospinal fluid leakage point. Initially patients were treated with medication. When patients complained of persistent headache, we performed epidural blood patch (EBP) administration. We performed subdural hematoma evacuation when it grew or worsened neurological status.
Twenty-one women (70%) and 9 men (30%) were enrolled. The mean age was 40 years (range: 30-58 years). After initial diagnosis with MRI, RI cisternography and CT myelography were helpful in pinpointing the exact leakage site. Four patients were treated only with the medication and 24 patients were treated with the epidural blood patch (EBP). Half of them achieved dramatic relief of symptoms after the initial EBP. A blind EBP was performed in 15 patients. Six patients experienced recurrence of symptoms. Hematoma evacuation was performed in 8 patients. None of diagnostic tools or treatment methods showed distinct superiority in predicting a favorable clinical outcome.
Clinicians should be systematic in their approach to plan a treatment regimen for patients with SIH. We suggest the use of a flow diagram when determining how to best approach and treat patients with SIH.
我们分析了颅内低压患者的临床经验，并建立了一个主要使用放射性同位素脑池造影术诊断和治疗自发性颅内低压（SIH）的策略模型。
我们回顾性分析了2000年1月至2006年12月期间30例SIH患者的临床经验。所有患者均经磁共振成像（MRI）确诊。采用放射性同位素脑池造影术或计算机断层扫描（CT）脊髓造影术来发现脑脊液漏点。最初患者接受药物治疗。当患者主诉持续性头痛时，我们进行硬膜外血贴（EBP）治疗。当硬膜下血肿增大或神经功能状态恶化时，我们进行硬膜下血肿清除术。
纳入21名女性（70%）和9名男性（30%）。平均年龄为40岁（范围：30 - 58岁）。在通过MRI初步诊断后，放射性同位素脑池造影术和CT脊髓造影术有助于精确确定确切的漏液部位。4例患者仅接受药物治疗，24例患者接受了硬膜外血贴（EBP）治疗。其中一半患者在首次EBP治疗后症状显著缓解。15例患者进行了盲法EBP治疗。6例患者症状复发。8例患者进行了血肿清除术。在预测良好的临床结局方面，没有一种诊断工具或治疗方法显示出明显的优势。
临床医生在为SIH患者制定治疗方案时应采用系统的方法。我们建议在确定如何最佳地诊治SIH患者时使用流程图。
