Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study.
OBJECTIVE
Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak.


METHODS
The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22-55 years). The mean duration of follow up was 36 months (range 6-132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients.


CONCLUSIONS
Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.
Schievink
Wouter I
WI
Maxine Dunitz Neurosurgical Institute, Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. schievinkw@cshs.org
Maya
M Marcel
MM
Riedinger
Mary
M
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D013353:Subdural Effusion / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D013997:Time Factors