Janssen Insa, Gempt Jens, Gerhardt Julia, Meyer Bernhard, Ryang Yu-Mi
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Acta Neurochir (Wien). 2016 Feb;158(2):273-8. doi: 10.1007/s00701-015-2653-8. Epub 2015 Dec 5.
Spontaneous spinal cerebrospinal fluid (CSF) leaks are rare (5 per 100,000 per year). Treatment generally consists of conservative therapy or interventional therapy with epidural blood patching. Surgical treatment is conducted rarely, usually in cases when conservative or interventional treatment has failed. The aim of our case series was to assess the clinical outcome after surgery.
Our clinical database was reviewed for patients with spontaneous spinal CSF leaks who underwent surgical exploration between 2010 and 2013. Etiology, symptoms, preoperative imaging, type of required surgical method, intraoperative findings, and clinical outcome were reported.
We identified five patients with a mean age of 62 years with spontaneous spinal CSF leaks who were treated surgically. Two patients received surgery after failure of interventional treatment. The origin of the CSF leak could be identified intraoperatively in three cases. Surgical technique in all cases consisted of an interlaminar fenestration or hemilaminectomy and a complete foraminotomy to explore the thecal sack and the exiting nerve roots and identify the CSF leak. After surgery, the preoperative symptoms improved in all patients. In one case, there was a relapse after 4 weeks.
Preoperative identification of a CSF leak with MRI was positive in only one case. In all other cases, a post-myelography CT had to be performed. In all cases, the preoperative symptoms improved after surgery. Surgical treatment is an effective treatment of spontaneous cerebrospinal fluid leaks in cases of refractory symptoms after failed conservative or interventional treatment.
自发性脊髓脑脊液漏较为罕见（每年每10万人中有5例）。治疗通常包括保守治疗或采用硬膜外血贴的介入治疗。手术治疗很少进行，通常在保守或介入治疗失败的情况下才进行。我们这个病例系列的目的是评估手术后的临床结果。
我们回顾了临床数据库中2010年至2013年间接受手术探查的自发性脊髓脑脊液漏患者。报告了病因、症状、术前影像学检查、所需手术方法的类型、术中发现以及临床结果。
我们确定了5例平均年龄为62岁的自发性脊髓脑脊液漏患者接受了手术治疗。2例患者在介入治疗失败后接受了手术。3例患者术中可确定脑脊液漏的来源。所有病例的手术技术均包括椎板间开窗或半椎板切除术以及完整的椎间孔切开术，以探查硬脊膜囊和穿出神经根并确定脑脊液漏。手术后，所有患者的术前症状均有所改善。1例患者在4周后复发。
术前通过磁共振成像（MRI）对脑脊液漏的识别仅在1例中呈阳性。在所有其他病例中，必须进行脊髓造影后CT检查。在所有病例中，手术后术前症状均有所改善。对于保守或介入治疗失败后出现难治性症状的自发性脑脊液漏病例，手术治疗是一种有效的治疗方法。
