Volz Florian, El Rahal Amir, Fung Christian, Shah Mukesch, Lützen Niklas, Urbach Horst, Beck Jürgen, Wolf Katharina
Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
J Neurol. 2024 May;271(5):2776-2786. doi: 10.1007/s00415-024-12242-2. Epub 2024 Feb 26.
Microsurgical sealing of spinal cerebrospinal fluid (CSF) leaks is a viable treatment option in spontaneous intracranial hypotension (SIH). Several factors may influence the outcome, with symptom duration probably the most modifiable variable.
Patients with closure of spinal CSF leaks between September 2020 and March 2023 and a follow-up period of 6 months were included in this retrospective single-center study. Pre- and postoperative scores for impact of headaches (Headache Impact Test, HIT-6) and quality of life (QoL, EQ-5D-5L) were systematically collected. Multiple regression modelling and subgroup analyses for different symptom durations and comorbidities were performed for these outcomes.
One hundred patients (61% female, median age 43.5 years) were included. Six months postoperatively, there was significant improvement in headache impact (HIT-6: 66 (IQR 62-69) to 52 (IQR 40-61, p < 0.001) and QoL (EQ-5D-5L VAS: 40 (IQR 30-60) to 79 (IQR 60-90); EQ-5D-5L Index: 0.67 (IQR 0.35-0.8) to 0.91 (IQR 0.8-0.94, p < 0.001, respectively). Subgroup analysis for a symptom duration above (74%) and below 90 days (26%) and comorbidity, as well as multiple regression analysis, revealed a trend in favor of early treatment and lower comorbidity. However, even after a prolonged symptom duration, improvements were significant.
As patients with shorter symptom duration show a trend for a better outcome, our results promote a timely diagnosis and treatment in SIH patients. However, a significant postoperative improvement can still be expected even after a prolonged symptom duration.
显微外科封闭脊髓脑脊液漏是自发性颅内低压（SIH）的一种可行治疗选择。有几个因素可能影响治疗结果，其中症状持续时间可能是最可调整的变量。
本回顾性单中心研究纳入了2020年9月至2023年3月期间脊髓脑脊液漏封闭且随访6个月的患者。系统收集术前和术后头痛影响（头痛影响测试，HIT-6）和生活质量（QoL，EQ-5D-5L）评分。对这些结果进行了不同症状持续时间和合并症的多元回归建模及亚组分析。
纳入100例患者（61%为女性，中位年龄43.5岁）。术后6个月，头痛影响（HIT-6：从66（四分位间距62 - 69）降至52（四分位间距40 - 61，p < .001））和生活质量（EQ-5D-5L视觉模拟评分：从40（四分位间距30 - 60）升至79（四分位间距60 - 90）；EQ-5D-5L指数：从0.67（四分位间距0.35 - 0.8）升至0.91（四分位间距0.8 - 0.94，p均 < .001））有显著改善。对症状持续时间高于（74%）和低于90天（26%）以及合并症的亚组分析以及多元回归分析显示，有早期治疗和较低合并症更有利的趋势。然而，即使症状持续时间较长，改善也很显著。
由于症状持续时间较短的患者显示出预后较好的趋势，我们的结果促使对SIH患者进行及时诊断和治疗。然而，即使症状持续时间较长，术后仍可预期有显著改善。
