title: Spontaneous intracranial hypotension secondary to anterior thoracic osteophyte: Resolution after primary dural repair via posterior approach.
abstract: BACKGROUND
  Spontaneous intracranial hypotension (SIH) is an uncommon syndrome widely attributed to CSF hypovolemia, typically secondary to spontaneous CSF leak. Although commonly associated with postural headache and variable neurological symptoms, one of the most severe consequences of SIH is bilateral subdural hematomas with resultant neurological deterioration.
  
  
  METHODS
  We present the case of a patient diagnosed with SIH secondary to an anteriorly positioned thoracic osteophyte with resultant dural disruption, who after multiple attempts at nonsurgical management developed bilateral subdural hematomas necessitating emergent surgical intervention. The patient underwent a unilateral posterior repair of his osteophyte with successful anterior decompression. At 36months follow up, the patient reported completely resolved headaches with no focal neurological deficits.
  
  
  CONCLUSIONS
  We outline our posterior approach to repair of the dural defect and review the management algorithm for the treatment of patients with SIH. We also examine the current hypotheses as to the origin, pathophysiology, diagnosis and treatment of this syndrome.
  
  
  CONCLUSIONS
  A posterior approach was utilized to repair the dural defect caused by an anterior thoracic osteophyte in a patient with severe SIH complicated by bilateral subdural hematomas. This approach minimizes morbidity compared to an anterior approach and allowed for removal of the osteophyte and repair of the dural defect.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.forename: Gaurav
authors.initials: G
authors.lastname: Gupta
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.forename: Scott C
authors.initials: SC
authors.lastname: Berta
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Mindea
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang