Schievink Wouter I, Deline Constance R
Department of Neurosurgery, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Sixth Floor, A-6600, Los Angeles, CA, 90048, USA,
Curr Pain Headache Rep. 2014 Nov;18(11):457. doi: 10.1007/s11916-014-0457-9.
Intracranial hypotension is known to occur as a result of spinal cerebrospinal fluid (CSF) leaking, which may be iatrogenic, traumatic, or spontaneous. Headache is usually, but not always, orthostatic. Spontaneous cases are recognized more readily than in previous decades as a result of a greater awareness of clinical presentations and typical cranial magnetic resonance imaging findings. An underlying disorder of connective tissue that predisposes to weakness of the dura is implicated in spontaneous spinal CSF leaks. CT, MR, and digital subtraction myelography are the imaging modalities of choice to identify spinal CSF leakage. Spinal imaging protocols continue to evolve with improved diagnostic sensitivity. Epidural blood patching is the most common initial intervention for those seeking medical attention, and may be repeated several times. Surgery is reserved for cases that fail to respond or relapse after simpler measures. While the prognosis is generally good with intervention, serious complications do occur. More research is needed to better understand the genetics and pathophysiology of dural weakness as well as physiologic compensatory mechanisms, to continue to refine imaging modalities and treatment approaches, and to evaluate short- and long-term clinical outcomes.
已知颅内低压是由脊髓脑脊液（CSF）漏出所致，其可能为医源性、外伤性或自发性的。头痛通常（但并非总是）与体位有关。由于对临床表现和典型头颅磁共振成像结果的认识提高，自发性病例比前几十年更容易被识别。易导致硬脑膜薄弱的潜在结缔组织疾病与自发性脊髓脑脊液漏有关。CT、MR和数字减影脊髓造影是识别脊髓脑脊液漏的首选成像方式。脊髓成像方案随着诊断敏感性的提高而不断发展。硬膜外血贴是寻求医疗救治者最常见的初始干预措施，可能需要重复多次。手术适用于采取更简单措施后无效或复发的病例。虽然干预后的预后通常良好，但严重并发症确实会发生。需要更多研究来更好地理解硬脑膜薄弱的遗传学和病理生理学以及生理代偿机制，继续完善成像方式和治疗方法，并评估短期和长期临床结果。
