title: Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension.
abstract: BACKGROUND
  This study aimed to evaluate the diagnostic imaging findings and treatment results of patients with idiopathic intracranial hypotension (IIH) due to cerebrospinal fluid (CSF) leaks.
  
  
  METHODS
  Between February 2009 and April 2012, 26 IIH patients (15 men, median age 49 years) presenting with orthostatic headache (n = 20) and/or with spontaneous subdural effusions or subarachnoid hemorrhage (n = 19) were enrolled. Twenty-three patients underwent a whole spine CT and MRI myelography, starting 45 min after the intrathecal injection of 9 cc of iomeprol (Imeron 300 M) and 1 cc of gadobutrolum (Gadovist). Three patients only underwent MR myelography after intrathecal gadobutrolum injection. Adjacent to the level(s) of the detected CSF leak(s) along the nerve roots, 20 cc of fresh venous blood with 0.5 cc Gadovist was injected epidurally (blood patch, BP). The distribution of the BP was visualized by MRI the following day. Treatment results were evaluated clinically and by myelography 2 weeks after the application of the BP. Retreatment was offered to patients with persistent symptoms and continued CSF leakage.
  
  
  RESULTS
  CSF leaks were detected at the cervical (n = 12), thoracic (n = 25), or lumbar (n = 21) spine. In 23 patients, more than one spinal segment was affected. One patient refused treatment. BP were applied in one (n = 9) or several (n = 16) levels. Clinical and/or radiological improvement was achieved after one (n = 16), two (n = 5), three (n = 3), or five (n = 1) BPs.
  
  
  CONCLUSIONS
  CT and MRI myelography allow the reliable detection of spinal CSF leaks. The targeted and eventually repeated epidural BP procedure is a safe and efficacious treatment.
authors: Klinik für Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors: G
authors: G
authors: Albes
authors: H
authors: H
authors: Weng
authors: D
authors: D
authors: Horvath
authors: C
authors: C
authors: Musahl
authors: H
authors: H
authors: Bäzner
authors: H
authors: H
authors: Henkes
mesh_terms: D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D002555:Cerebrospinal Fluid / Q000502:physiology*; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D007427:Intracranial Pressure / Q000502:physiology; D007479:Iopamidol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C057937:iomeprol; C090600:gadobutrol; D007479:Iopamidol; D019786:Gadolinium DTPA