Distinct Pattern of Membrane Formation With Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
25 Sep 2023
25 Sep 2023
Historique:
received:
14
06
2023
accepted:
18
07
2023
pmc-release:
25
09
2024
medline:
25
9
2023
pubmed:
25
9
2023
entrez:
25
9
2023
Statut:
aheadofprint
Résumé
To systematically describe pertinent, intraoperative anatomic findings encountered when approaching spinal cerebrospinal fluid (CSF) leaks and CSF-venous fistulas in spontaneous intracranial hypotension (SIH). In a retrospective study, we included surgically treated patients suffering from SIH at our institution from April 2018 to March 2022. Anatomic, intraoperative data were extracted from operative notes and supplemented with data from surgical videos and images. Prominent anatomic features were compared among different types of CSF leaks. The study cohort consists of 120 patients with a mean age of 45.2 years. We found four distinct patterns of spinal membranes specifically associated with different types of CSF leaks: (i) thick, dorsal membranes, which were hypervascular and may mimic the dura (pseudodura); (ii) thin, lateral membranes encapsulating a ventral epidural CSF compartment (confining the spinal longitudinal extradural CSF collection); (iii) ventral membranes constituting a transdural funnel-like CSF channel; and (iv) lateral membranes forming spinal cysts/meningeal diverticulae associated with lateral CSF leaks. The latter three types resemble a layer of arachnoid herniated through the dural defect. We describe four distinct spinal (neo-)membranes in association with spinal CSF leaks. Formation of these membranes, or emergence by herniation of arachnoid through a dural defect, constitutes a specific pathoanatomic feature of patients with SIH and CSF leaks. Recognition of these membranes is of paramount importance for diagnosis and treatment of patients with spinal CSF leaks.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
To systematically describe pertinent, intraoperative anatomic findings encountered when approaching spinal cerebrospinal fluid (CSF) leaks and CSF-venous fistulas in spontaneous intracranial hypotension (SIH).
METHODS
METHODS
In a retrospective study, we included surgically treated patients suffering from SIH at our institution from April 2018 to March 2022. Anatomic, intraoperative data were extracted from operative notes and supplemented with data from surgical videos and images. Prominent anatomic features were compared among different types of CSF leaks.
RESULTS
RESULTS
The study cohort consists of 120 patients with a mean age of 45.2 years. We found four distinct patterns of spinal membranes specifically associated with different types of CSF leaks: (i) thick, dorsal membranes, which were hypervascular and may mimic the dura (pseudodura); (ii) thin, lateral membranes encapsulating a ventral epidural CSF compartment (confining the spinal longitudinal extradural CSF collection); (iii) ventral membranes constituting a transdural funnel-like CSF channel; and (iv) lateral membranes forming spinal cysts/meningeal diverticulae associated with lateral CSF leaks. The latter three types resemble a layer of arachnoid herniated through the dural defect.
CONCLUSION
CONCLUSIONS
We describe four distinct spinal (neo-)membranes in association with spinal CSF leaks. Formation of these membranes, or emergence by herniation of arachnoid through a dural defect, constitutes a specific pathoanatomic feature of patients with SIH and CSF leaks. Recognition of these membranes is of paramount importance for diagnosis and treatment of patients with spinal CSF leaks.
Identifiants
pubmed: 37747369
doi: 10.1227/ons.0000000000000914
pii: 01787389-990000000-00885
pmc: PMC10688773
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Stiftung Professor Dr. Max Cloëtta
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Congress of Neurological Surgeons.
Références
Cephalalgia. 2018 Jan;38(1):1-211
pubmed: 29368949
Oper Neurosurg (Hagerstown). 2020 Mar 1;18(3):239-245
pubmed: 31134267
Cephalalgia. 2008 Dec;28(12):1345-56
pubmed: 19037970
JAMA. 2006 May 17;295(19):2286-96
pubmed: 16705110
Cephalalgia. 2019 Feb;39(2):306-315
pubmed: 30099952
Cephalalgia. 2019 Dec;39(14):1847-1854
pubmed: 31597463
J Neurol Neurosurg Psychiatry. 2016 Jun;87(6):650-5
pubmed: 26285586
Neurology. 2014 Jul 29;83(5):472-3
pubmed: 24951475
J Neurosurg. 2014 Dec;121(6):1380-7
pubmed: 25036203
Neurology. 2016 Aug 16;87(7):673-9
pubmed: 27440149
J Neurol. 2022 Mar;269(3):1439-1446
pubmed: 34274993
AJNR Am J Neuroradiol. 2019 Apr;40(4):745-753
pubmed: 30923083
Neurology. 2020 Jul 21;95(3):e247-e255
pubmed: 32522800
Lancet Neurol. 2022 Apr;21(4):369-380
pubmed: 35227413
Radiology. 2018 Dec;289(3):766-772
pubmed: 30226459
Clin Neuroradiol. 2021 Sep;31(3):633-641
pubmed: 32845353
Neurosurgery. 2019 Jun 1;84(6):E345-E351
pubmed: 30053151
J Neurosurg. 2011 Feb;114(2):505-9
pubmed: 20932091
Neurology. 2016 Sep 20;87(12):1220-6
pubmed: 27566748
Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-238-45; discussion ONS-245
pubmed: 16582646
J Neurosurg Spine. 2017 Aug;27(2):227-234
pubmed: 28574328
Oper Neurosurg (Hagerstown). 2023 May 1;24(5):e336-e341
pubmed: 37068025
AJR Am J Roentgenol. 2021 Dec;217(6):1418-1429
pubmed: 34191547
J Neurosurg Spine. 2022 Sep 09;38(1):147-152
pubmed: 36087332