Spontaneous intracranial hypotension: updates from diagnosis to treatment.
CSF leak
Digital subtraction myelography
Dynamic CT myelography
Orthostatic headache
Sponaneous intracranial hypotension
Tranvenous Onyx embolization
Journal
Neuroradiology
ISSN: 1432-1920
Titre abrégé: Neuroradiology
Pays: Germany
ID NLM: 1302751
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
14
09
2022
accepted:
26
10
2022
pubmed:
7
11
2022
medline:
25
1
2023
entrez:
6
11
2022
Statut:
ppublish
Résumé
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
Identifiants
pubmed: 36336758
doi: 10.1007/s00234-022-03079-5
pii: 10.1007/s00234-022-03079-5
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
233-243Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
D’Antona L et al (2021) Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis. JAMA Neurol 78(3):329–337
doi: 10.1001/jamaneurol.2020.4799
Schievink WI et al (2022) Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006–2020. Cephalalgia 42(4–5):312–316
doi: 10.1177/03331024211048510
Schrijver I et al (2002) Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy. J Neurosurg 96(3):483–489
doi: 10.3171/jns.2002.96.3.0483
Lay CM (2002) Low cerebrospinal fluid pressure headache. Curr Treat Options Neurol 4(5):357–363
doi: 10.1007/s11940-002-0046-9
Guan J, Couldwell WT, Taussky P (2014) Intracranial hypotension as a complication of lumbar puncture prior to elective aneurysm clipping. Surg Neurol Int 5(Suppl 9):S427–S429
Liaquat MT, Jain S (2022) Spontaneous intracranial hypotension, in StatPearls. Treasure Island (FL)
Schievink WI et al (2005) Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg 103(4):608–613
doi: 10.3171/jns.2005.103.4.0608
Madhavan AA et al. (2022) Combined CSF-venous fistula and middle meningeal artery embolization for treatment of spontaneous intracranial hypotension. Interv Neuroradiol p. 15910199221109044
Caton MT Jr et al (2021) Spinal compliance curves: preliminary experience with a new tool for evaluating suspected CSF venous fistulas on CT myelography in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 42(5):986–992
doi: 10.3174/ajnr.A7018
Kumar N et al (2018) A novel etiology for craniospinal hypovolemia: a case of inferior vena cava obstruction. J Neurosurg Spine 29(4):452–455
doi: 10.3171/2018.2.SPINE171373
Goldberg J et al (2021) Spontaneous intracranial hypotension without CSF leakage-concept of a pathological cranial to spinal fluid shift. Front Neurol 12:760081
doi: 10.3389/fneur.2021.760081
Mokri B, Aksamit AJ, Atkinson JL (2004) Paradoxical postural headaches in cerebrospinal fluid leaks. Cephalalgia 24(10):883–887
doi: 10.1111/j.1468-2982.2004.00763.x
Savoiardo M et al (2006) Dural sinus thrombosis in spontaneous intracranial hypotension: hypotheses on possible mechanisms. J Neurol 253(9):1197–1202
doi: 10.1007/s00415-006-0194-z
Capizzano AA et al (2016) Atypical presentations of intracranial hypotension: comparison with classic spontaneous intracranial hypotension. AJNR Am J Neuroradiol 37(7):1256–1261
doi: 10.3174/ajnr.A4706
Wicklund MR et al (2011) Frontotemporal brain sagging syndrome: an SIH-like presentation mimicking FTD. Neurology 76(16):1377–1382
doi: 10.1212/WNL.0b013e3182166e42
Wilson D et al (2017) Infratentorial superficial siderosis: classification, diagnostic criteria, and rational investigation pathway. Ann Neurol 81(3):333–343
doi: 10.1002/ana.24850
Friedauer L et al (2022) Spinal dural leaks in patients with infratentorial superficial siderosis of the central nervous system-refinement of a diagnostic algorithm. Eur J Neurol 29(4):1136–1144
doi: 10.1111/ene.14611
Takai K, Taniguchi M (2021) Superficial siderosis of the central nervous system associated with ventral dural defects: bleeding from the epidural venous plexus. J Neurol 268(4):1491–1494
doi: 10.1007/s00415-020-10319-2
Schievink WI, Wasserstein P, Maya MM (2016) Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases. J Neurosurg Spine 24(3):454–456
doi: 10.3171/2015.6.SPINE15428
Schievink WI et al (2021) Long-term risks of persistent ventral spinal CSF leaks in SIH: superficial siderosis and bibrachial amyotrophy. Neurology 97(19):e1964–e1970
doi: 10.1212/WNL.0000000000012786
Schievink WI et al (2016) A classification system of spontaneous spinal CSF leaks. Neurology 87(7):673–679
doi: 10.1212/WNL.0000000000002986
Thielen KR et al (2015) Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes. J Neurosurg Spine 22(3):324–331
doi: 10.3171/2014.10.SPINE14209
Schievink WI et al (2016) Vanishing calcification associated with a spontaneous ventral spinal cerebrospinal fluid leak. Cephalalgia 36(14):1366–1369
doi: 10.1177/0333102416628468
Madhavan AA et al (2022) Osseous spicules of the posterior elements causing fast cerebrospinal fluid leaks. Neuroradiology
Cohen-Gadol AA et al (2006) Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks. Neurosurgery 58 (4 Suppl 2): p. ONS-238–45; discussion ONS-245
Kranz PG et al (2013) Spinal meningeal diverticula in spontaneous intracranial hypotension: analysis of prevalence and myelographic appearance. AJNR Am J Neuroradiol 34(6):1284–1289
doi: 10.3174/ajnr.A3359
Schievink WI, Moser FG, Maya MM (2014) CSF-venous fistula in spontaneous intracranial hypotension. Neurology 83(5):472–473
doi: 10.1212/WNL.0000000000000639
Madhavan AA et al (2020) Association between Klippel-Trenaunay syndrome and spontaneous intracranial hypotension: a report of 4 patients. World Neurosurg 138:398–403
doi: 10.1016/j.wneu.2020.03.148
Schievink WI et al (2021) Multiple spinal CSF leaks in spontaneous intracranial hypotension: do they exist? Neurol Clin Pract 11(5):e691–e697
doi: 10.1212/CPJ.0000000000001084
Mamlouk MD et al (2022) Spontaneous spinal CSF leaks stratified by age, body mass index, and spinal level. AJNR Am J Neuroradiol 43(7):1068–1072
doi: 10.3174/ajnr.A7548
Farb RI et al (2019) Spontaneous intracranial hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography. AJNR Am J Neuroradiol 40(4):745–753
Dobrocky T et al (2019) Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol 76(5):580–587
doi: 10.1001/jamaneurol.2018.4921
Alcaide-Leon P et al (2016) Prominent inferior intercavernous sinus on sagittal T1-weighted images: a sign of intracranial hypotension. AJR Am J Roentgenol 206(4):817–822
doi: 10.2214/AJR.15.14872
Kim DK et al (2021) Diagnostic yield of lateral decubitus digital subtraction myelogram stratified by brain MRI findings. Neurology 96(9):e1312–e1318
doi: 10.1212/WNL.0000000000011522
Dobrocky T et al (2020) Monro-Kellie hypothesis: increase of ventricular CSF volume after surgical closure of a spinal dural leak in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 41(11):2055–2061
doi: 10.3174/ajnr.A6782
Ferrante E et al (2021) Cerebral venous thrombosis in spontaneous intracranial hypotension: a report of 8 cases and review of the literature. J Neurol Sci 425:117467
doi: 10.1016/j.jns.2021.117467
Madhavan AA et al (2022) Lateral decubitus dynamic CT myelography for fast cerebrospinal fluid leak localization. Neuroradiology
Stephen CD et al (2016) Complicated spontaneous intracranial hypotension treated with intrathecal saline infusion. Pract Neurol 16(2):146–149
doi: 10.1136/practneurol-2015-001231
Houk JL et al (2022) Dual energy CT for the identification of CSF-venous fistulas and CSF leaks in spontaneous intracranial hypotension: report of four cases. Radiol Case Rep 17(5):1824–1829
doi: 10.1016/j.radcr.2022.02.053
Schwartz FR, Malinzak MD, Amrhein TJ (2022) Photon-counting computed tomography scan of a cerebrospinal fluid venous fistula. JAMA Neurol 79(6):628–629
doi: 10.1001/jamaneurol.2022.0687
Amrhein TJ et al (2020) Respiratory phase affects the conspicuity of CSF-venous fistulas in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 41(9):1754–1756
Kinsman KA et al (2019) Renal contrast on CT myelography: diagnostic value in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 40(2):376–381
doi: 10.3174/ajnr.A5934
Shlapak DP et al (2020) Time to resolution of inadvertent subdural contrast injection during a myelogram: when can the study be reattempted? AJNR Am J Neuroradiol 41(10):1958–1962
doi: 10.3174/ajnr.A6725
Carlton Jones L, Goadsby PJ (2022) Same-day bilateral decubitus CT myelography for detecting CSF-venous fistulas in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 43(4):645–648
doi: 10.3174/ajnr.A7476
Madhavan AA et al (2021) Diagnostic yield of intrathecal gadolinium mR myelography for CSF leak localization. Clin Neuroradiol
Clark MS et al (2018) Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography. Diagn Interv Radiol 24(1):54–59
doi: 10.5152/dir.2017.17220
Schievink WI et al (1996) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84(4):598–605
doi: 10.3171/jns.1996.84.4.0598
Mokri B (2013) Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache 53(7):1034–1053
doi: 10.1111/head.12149
Mokri B (2014) Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin 32(2):397–422
doi: 10.1016/j.ncl.2013.11.002
Schievink WI (2008) Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia 28(12):1345–1356
doi: 10.1111/j.1468-2982.2008.01776.x
Schwedt TJ, Dodick DW (2007) Spontaneous intracranial hypotension. Curr Pain Headache Rep 11(1):56–61
doi: 10.1007/s11916-007-0023-9
Yuh EL, Dillon WP (2010) Intracranial hypotension and intracranial hypertension. Neuroimaging Clin N Am 20(4):597–617
doi: 10.1016/j.nic.2010.07.012
Kong DS et al (2005) Clinical features and long-term results of spontaneous intracranial hypotension. Neurosurgery 57(1): p. 91–6; discussion 91–6.
Su CS et al (2009) Clinical features, neuroimaging and treatment of spontaneous intracranial hypotension and magnetic resonance imaging evidence of blind epidural blood patch. Eur Neurol 61(5):301–307
doi: 10.1159/000206856
Hannerz J et al (2006) Treatment of idiopathic intracranial hypotension: cervicothoracic and lumbar blood patch and peroral steroid treatment. Headache 46(3):508–511
doi: 10.1111/j.1526-4610.2006.00383.x
Pagani-Estevez GL et al (2019) Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension. Reg Anesth Pain Med
Sencakova D, Mokri B, McClelland RL (2001) The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57(10):1921–1923
doi: 10.1212/WNL.57.10.1921
Cho KI et al (2011) Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology 76(13):1139–1144
doi: 10.1212/WNL.0b013e318212ab43
Kranz PG, Gray L, Taylor JN (2011) CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 32(5):832–838
doi: 10.3174/ajnr.A2384
Rai A et al (2005) Epidural blood patch at C2: diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 26(10):2663–2666
Park ES, Kim E (2009) Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment. J Korean Neurosurg Soc 45(1):1–4
doi: 10.3340/jkns.2009.45.1.1
Agarwal V, Sreedher G, Rothfus WE (2013) Targeted CT-guided epidural blood patch for treatment of spontaneous intracranial hypotension due to calcified intradural thoracic disc herniation. Interv Neuroradiol 19(1):121–126
doi: 10.1177/159101991301900118
Allmendinger AM, Lee TC (2013) Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch. Clin Imaging 37(4):756–761
doi: 10.1016/j.clinimag.2012.11.006
Mehta B, Tarshis J (2009) Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension. Can J Anaesth 56(8):609–613
doi: 10.1007/s12630-009-9121-y
Schievink WI, Maya MM, Moser FM (2004) Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant. Report of four cases J Neurosurg 100(6):1098–1100
Kamada M et al (2000) Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue. Headache 40(10):844–847
doi: 10.1111/j.1526-4610.2000.00153.x
Mokri B (2008) Expert commentary: role of surgery for the management of CSF leaks. Cephalalgia 28(12):1357–1360
doi: 10.1111/j.1468-2982.2008.01777.x
Maher CO, Meyer FB, Mokri B (2000) Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. Neurosurg Focus 9(1):e7
doi: 10.3171/foc.2000.9.1.7
Witiw CD et al (2012) Surgical treatment of spontaneous intracranial hypotension secondary to degenerative cervical spine pathology: a case report and literature review. Eur Spine J 21(Suppl 4):S422–S427
doi: 10.1007/s00586-011-1979-z
Brinjikji W et al (2022) Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization. J Neurointerv Surg
Mamlouk MD et al (2021) CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas. Radiology 299(2):409–418
doi: 10.1148/radiol.2021204231
Schievink WI (2009) A novel technique for treatment of intractable spontaneous intracranial hypotension: lumbar dural reduction surgery. Headache 49(7):1047–1051
doi: 10.1111/j.1526-4610.2009.01450.x
Carlton Jones L, Butteriss D, Scoffings D (2022) Spontaneous intracranial hypotension: the role of radiology in diagnosis and management. Clin Radiol 77(3):e181–e194
doi: 10.1016/j.crad.2021.11.007
Luetzen N et al (2021) Spontaneous intracranial hypotension: diagnostic and therapeutic workup. Neuroradiology 63(11):1765–1772
doi: 10.1007/s00234-021-02766-z