Treatment, Outcome, and Relapse of Spontaneous and Nonspontaneous Cerebrospinal Fluid Leak

Cerebrospinal fluid (CSF) leak can be spontaneous or nonspontaneous. The management options include conservative treatments, blood patch, and surgical repairs. We compared clinical symptoms, image findings, management options, hospitalization, and relapse rates among different causes of CSF leaks. E...

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Bibliographic Details
Published in:Brain sciences 2022-03, Vol.12 (3), p.340
Main Authors: Tai, Yi-Cheng, Tai, Yi-Sheng, Ou, Chang-Hsien, Lui, Chun-Chung, Wang, Hao-Kuang, Kuo, Hung-Chang, Hsu, Shih-Pin
Format: Article
Language:English
Subjects:
Back surgery
blood patch
Body mass index
Bone surgery
Calvaria
Cerebrospinal fluid
CSF
Diagnostic tests
Head injuries
Headaches
Hemorrhage
Hospitalization
Hypotension
leak
Magnetic resonance imaging
Meningitis
Pain
Skull
Spine (lumbar)
spontaneous
Trauma
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Summary:Cerebrospinal fluid (CSF) leak can be spontaneous or nonspontaneous. The management options include conservative treatments, blood patch, and surgical repairs. We compared clinical symptoms, image findings, management options, hospitalization, and relapse rates among different causes of CSF leaks. Eighty-one patients were recruited: 20 with spontaneous and 61 with nonspontaneous CSF leaks. Nonspontaneous causes included lumbar puncture, surgery, and trauma. Surgery sites comprised sphenoid, spine, skull base, and calvaria. Spontaneous CSF leak came from the sphenoid or spine. Age, gender, body mass index, initial symptoms, hospitalization, treatment courses, and recurrence rates showed no difference between the groups. The spontaneous group had higher CSF accumulations on their MRIs. MRI pachymeninge enhancement showed the highest sensitivity (78.6%) for intracranial hypotension. Meningitis occurred in 1/3 of sphenoid, skull base, and calvarian surgeries. Earlier reoperation was correlated with shorter hospitalization (r = 0.651), but the recurrence rates were similar. Longer intervals between surgery and CSF leak encouraged reoperation. Among the spontaneous spine and lumbar puncture-related CSF leaks, 57.1% of them responded to 4 days of conservative treatment. Among the trauma-related CSF leaks, 90.9% of them required surgical repair. The demographic data and symptoms were similar in various groups of CSF leak. The symptom onset durations and treatment strategies were different. However, the recurrence rates were similar.
ISSN:2076-3425
2076-3425
DOI:10.3390/brainsci12030340