School of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Eur Spine J. 2012 Jun;21 Suppl 4(Suppl 4):S422-7. doi: 10.1007/s00586-011-1979-z. Epub 2011 Aug 27.
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.
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.
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.
Two months after this novel surgical blood patch procedure the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
脑脊液（CSF）通过退行性颈椎病理的硬脑膜裂口漏出是颅内低血压的罕见原因。据我们所知，英文文献中仅描述了四起病例。治疗具有挑战性，且因病例而异，仅有一名患者报告完全缓解症状。在此，我们复习文献并描述我们对一名 46 岁女性因颈椎脊膜囊穿透而出现症状性颅内低血压的手术治疗方法。
患者出现进行性直立性头痛 3 个月。磁共振成像显示双侧硬脑膜下血肿和脑膜钆增强。计算机断层脊髓造影显示颈椎 4-5 钙化椎间盘突出和骨赘处有前硬膜外 CSF 积聚。
三次不成功的腰部血液贴补后，我们选择尝试通过前路颈椎间盘切除术暴露并直接修复硬脑膜缺损以去除病因，如前所述。切除椎间盘-骨赘复合体并暴露硬脑膜后，手术部位立即有大量 CSF 与血液混合涌出。硬脑膜缺损不可见，但 CSF 涌出迅速停止。为了更好地暴露和直接修复缺陷，已经描述了颈椎椎体切除术，但我们认为这是不必要的，并且认为术中血液收集形成了局部血液贴补。通过椎间盘切除术间隙插入胶原硬脑膜替代膜以加强。
在这种新型手术血液贴补程序两个月后，患者无症状，随访影像学显示完全缓解。
