Schievink Wouter I, Maya M Marcel, Moser Franklin, Prasad Ravi, Wadhwa Vikram, Cruz Rachelle, Nuño Miriam
Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis.
Neurol Clin Pract. 2021 Oct;11(5):e691-e697. doi: 10.1212/CPJ.0000000000001084.
To determine the frequency of multiple spinal CSF leaks in a recent group of patients with spontaneous intracranial hypotension (SIH) who were investigated with digital subtraction myelography (DSM).
This observational study was conducted using data from a prospectively maintained data base of patients who meet the International Classification of Headache Disorders, third edition, criteria for SIH. The patient population consisted of a consecutive group of 745 patients with SIH who underwent DSM between March 2009 and February 2020. Based on the results of DSM, participants were classified according to the type and number of spinal CSF leaks.
Among 398 patients with SIH and extradural CSF on spinal imaging, multiplicity of CSF leaks was observed in none of 291 patients with type 1a ventral leaks and in 4 (6.2%) of 65 patients with type 1b (postero-) lateral leaks. Among 97 patients with SIH from spinal CSF-venous fistulas (type 3 leaks) who did not have extradural CSF on spinal imaging, 9 patients (9.3%) had multiple fistulas ( < 0.0001 for comparison between groups). Type 3 and type 1a or 1b CSF leaks coexisted in an additional 5 patients.
Among patients with SIH, multiplicity of CSF leaks was observed radiographically in none of the patients with ventral leaks, in 6% of patients with lateral leaks, and in 9% of patients with CSF-venous fistulas. These results suggest that patients with SIH can be reassured that the occurrence of multiple CSF leaks is negligible to uncommon at most, depending on the type of CSF leak.
确定近期一组经数字减影脊髓造影（DSM）检查的自发性颅内低压（SIH）患者中多发性脊髓脑脊液漏的发生率。
本观察性研究使用了一个前瞻性维护的数据库中的数据，该数据库包含符合《国际头痛疾病分类》第三版中SIH标准的患者。患者群体包括2009年3月至2020年2月期间连续接受DSM检查的745例SIH患者。根据DSM结果，参与者按脊髓脑脊液漏的类型和数量进行分类。
在398例脊髓影像学显示有硬膜外脑脊液的SIH患者中，291例1a型腹侧漏患者均未观察到脑脊液漏的多发性，65例1b型（后）外侧漏患者中有4例（6.2%）出现多发性脑脊液漏。在97例脊髓脑脊液静脉瘘（3型漏）导致的SIH患者中，脊髓影像学未显示硬膜外脑脊液，9例（9.3%）有多发性瘘（组间比较P<0.0001）。另有5例患者同时存在3型和1a型或1b型脑脊液漏。
在SIH患者中，影像学检查发现腹侧漏患者均未出现脑脊液漏的多发性，外侧漏患者中有6%出现，脑脊液静脉瘘患者中有9%出现。这些结果表明，SIH患者可以放心，多发性脑脊液漏的发生最多可忽略不计至不常见，具体取决于脑脊液漏的类型。
