Schievink W I, Morreale V M, Atkinson J L, Meyer F B, Piepgras D G, Ebersold M J
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Neurosurg. 1998 Feb;88(2):243-6. doi: 10.3171/jns.1998.88.2.0243.
Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks.
Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22-61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients.
All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3-58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.
自发性脊髓脑脊液漏是颅内低压越来越常见的病因，可能需要神经外科干预。在本报告中，作者回顾了他们对自发性脊髓脑脊液漏的手术治疗经验。
1992年至1997年间，对10例自发性脊髓脑脊液漏合并颅内低压的患者进行了手术治疗。7名女性和3名男性的平均年龄为42.3岁（范围22 - 61岁）。术前影像学检查显示，2例患者有单个脑膜憩室，1例患者有憩室复合体，7例患者仅有局灶性脑脊液漏。对这7例患者进行手术探查，其中1例发现脑膜憩室；其余6例未发现明确的脑脊液漏源。治疗方法包括结扎憩室或用肌肉或明胶海绵填充硬膜外间隙。3例患者同时存在多处脊髓脑脊液漏。
所有患者术后头痛均完全缓解。在平均19个月（范围3 - 58个月；累计随访16人年）的随访期内，所有患者均未出现症状复发。并发症包括1例患者出现短暂性颅内高压，另1例患者出现腿部麻木。尽管该病通常具有自限性，但手术治疗在自发性脊髓脑脊液漏的管理中具有重要作用。手术可有效消除头痛，且发病率通常较低。影像学检查显示的局灶性脑脊液漏进行手术探查，通常无法发现明确的漏源。一些患者可能同时存在多处脑脊液漏。
