A novel technique for treatment of intractable spontaneous intracranial hypotension: lumbar dural reduction surgery.
OBJECTIVE
Spontaneous intracranial hypotension has become a well-described cause of headache particularly among young and middle-aged individuals. Treatment of the underlying spinal cerebrospinal fluid (CSF) leak is effective in relieving symptoms in the vast majority of patients but symptoms may become refractory. The author describes a novel surgical technique to treat intractable spontaneous intracranial hypotension.


METHODS
A lumbar laminectomy is performed, a strip of dura is resected, and the dural defect is closed. The resulting decrease in lumbar CSF volume is believed to increase intracranial CSF volume and pressure.


RESULTS
The technique was utilized in a patient who suffered with intractable positional headaches because of a spinal CSF leak for 6 years in spite of numerous surgical and nonsurgical therapies. Significant improvement of symptoms was sustained during a 1-year period of follow-up.


CONCLUSIONS
Dural reduction surgery may be considered in carefully selected patients with intracranial hypotension.
Schievink
Wouter I
WI
Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA.
D000328:Adult; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008161:Lumbosacral Region; D011859:Radiography; D015898:Tomography Scanners, X-Ray Computed