El Rahal Amir, Haupt Benedikt, Wolf Katharina, Blass Bianca, Vasilikos Ioannis, Overstijns Manou, Shah Mukesch Johannes, Lützen Niklas, Urbach Horst, Häni Levin, Fung Christian, Beck Jürgen, Volz Florian
Department of Neurosurgery, Medical Center University of Freiburg, Freiburg , Germany.
Faculty of Medicine of the University of Geneva, Geneva , Switzerland.
Oper Neurosurg (Hagerstown). 2025 May 1;28(5):657-666. doi: 10.1227/ons.0000000000001401. Epub 2024 Oct 22.
Spinal cerebrospinal fluid (CSF) leaks may cause a myriad of clinical symptoms, the most common being orthostatic headache. Lateral leaks (Type II) and direct CSF-venous fistulas (Type III) are a subgroup of spinal CSF leaks, representing about 1/3 of spinal CSF leaks. This study aimed to analyze the risk and efficacy of nerve root clipping in patients with Type II and Type III CSF leaks.
All consecutive patients with Type II and Type III CSF fistulas treated with nerve root clipping at our institution from May 2018 to December 2022 were included. Patients were evaluated for postoperative sensory motor deficits and neuropathic pain using the "Douleur Neuropathique 4" questionnaire, and the outcome was evaluated using the "Patient Global Impression of Change" and the return-to-work rate.
A total of 40 patients were included, and the mean follow-up time was 22 months. According to the Patient Global Impression of Change, significant symptoms improvement was reported in 85% of patients. Over 87% of patients returned to work fully or partially. One patient experienced a low-grade motor deficit after T1-nerve root clipping. 2.5% of patients developed postoperative neuropathic pain requiring medical treatment under which they fully improved. Over 80% of patients developed dermatomal hypoesthesia, with no reported effect on quality of life.
The surgical strategy of noneloquent nerve root clipping shows favorable outcomes and return-to-work rates. There are instances of neuropathic pain and dermatomal hypoesthesia with no significant morbidity. Despite the favorable outcome and low recurrence rate, nerve root-sparing surgical techniques should be further explored.
脊髓脑脊液（CSF）漏可导致多种临床症状，最常见的是体位性头痛。侧方漏（II型）和直接脑脊液-静脉瘘（III型）是脊髓脑脊液漏的一个亚组，约占脊髓脑脊液漏的1/3。本研究旨在分析II型和III型脑脊液漏患者神经根夹闭术的风险和疗效。
纳入2018年5月至2022年12月在本机构接受神经根夹闭术治疗的所有连续II型和III型脑脊液瘘患者。使用“Douleur Neuropathique 4”问卷评估患者术后的感觉运动功能障碍和神经性疼痛，并使用“患者总体改善印象”和重返工作率评估结果。
共纳入40例患者，平均随访时间为22个月。根据患者总体改善印象，85%的患者报告症状有显著改善。超过87%的患者完全或部分重返工作岗位。1例患者在T1神经根夹闭术后出现轻度运动功能障碍。2.5%的患者出现术后神经性疼痛，经治疗后完全改善。超过80%的患者出现皮节感觉减退，未报告对生活质量有影响。
非明确神经根夹闭术的手术策略显示出良好的疗效和重返工作率。有神经性疼痛和皮节感觉减退的病例，但发病率不高。尽管预后良好且复发率低，但仍应进一步探索保留神经根的手术技术。
