Vishteh A G, Schievink W I, Baskin J J, Sonntag V K
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
J Neurosurg. 1998 Sep;89(3):483-4. doi: 10.3171/jns.1998.89.3.0483.
Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5-6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5-6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.
由于脊髓脑脊液（CSF）漏导致的自发性颅内低压是一种罕见但越来越被认识到的体位性头痛原因。这些脑脊液漏的确切原因通常仍不清楚。作者治疗了一名32岁患有自发性颅内低压独特病因的男性。他遭受剧烈头痛，直立位时头痛加剧。四血管脑动脉造影结果为阴性；然而，脑部磁共振（MR）成像显示硬脑膜强化和后脑疝。做出了自发性颅内低压的初步诊断。脊髓造影显示颈髓腹侧有鞘外造影剂以及C5 - 6处有异常的中线骨赘。应用硬膜外血贴后患者症状未缓解，随后对C5 - 6骨赘采用前路手术。椎间盘切除术后，发现一个细长的骨赘已穿透硬脊膜囊。将其切除后，用两根间断的普理灵缝线缝合硬脑膜裂口。患者2天后出院回家。随访时他的症状已缓解，MR成像显示硬脑膜强化已消失，小脑疝略有改善。
