Department of Anaesthesia and Perioperative Medicine, Monash Health, Victoria, Australia.
Monash Imaging, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
J Clin Neurosci. 2023 May;111:46-56. doi: 10.1016/j.jocn.2023.03.005. Epub 2023 Mar 20.
Spontaneous intracranial hypotension from spinal cerebrospinal fluid leak is a condition that often presents as orthostatic headaches. Diagnosis and localisation of spinal CSF leaks remain difficult despite multiple imaging modalities that can be used to aid identification. These include traditional CT myelography and MRI as well as newer techniques such as dynamic and digital subtraction myelography. Leaks can be classified into types and optimal localisation and management techniques vary by type of leak. Localisation of a leak can aid in targeting treatment such as an epidural blood patch if conservative measures fail. Where unsuccessful, repeated blood patches and novel techniques can be used to improve patient symptoms. Much of this condition is not well understood and evidence is lacking, with many avenues for potential research.
自发性颅内低血压伴脊髓脑脊液漏是一种常表现为直立性头痛的病症。尽管有多种影像学方法可用于辅助识别，但诊断和定位脊髓脑脊液漏仍然很困难。这些方法包括传统的 CT 脊髓造影和 MRI 以及新兴技术，如动态和数字减影脊髓造影。漏液可分为不同类型，最佳的定位和管理技术因漏液类型而异。漏液的定位有助于靶向治疗，例如如果保守治疗失败，可以进行硬膜外血贴。如果治疗失败，可以反复进行血贴和使用新的技术来改善患者的症状。这种情况很大程度上尚未被充分了解，缺乏证据，有许多潜在的研究途径。
