Treatment strategy for cerebral hypotension caused by spontaneous XXXX .

@entity1 @entity5173
OBJECTIVE: Spontaneous spinal cerebrospinal fluid (CSF) leaks are rare (5 per 100,000 per year). Treatment generally consists of conservative therapy or interventional therapy with epidural blood patching. Surgical treatment is conducted rarely, usually in cases when conservative or interventional treatment has failed. The aim of our case series was to assess the clinical outcome after surgery. METHODS: Our clinical database was reviewed for @entity1 with spontaneous spinal CSF leaks who underwent surgical exploration between 2010 and 2013. Etiology, symptoms, preoperative imaging, type of required surgical method, intraoperative findings, and clinical outcome were reported. RESULTS: We identified five @entity1 with a mean age of 62  years with spontaneous spinal CSF leaks who were treated surgically. Two @entity1 received surgery after failure of interventional treatment. The origin of the CSF leak could be identified intraoperatively in three cases. Surgical technique in all cases consisted of an interlaminar fenestration or hemilaminectomy and a complete foraminotomy to explore the thecal sack and the exiting nerve roots and identify the CSF leak. After surgery, the preoperative symptoms improved in all @entity1 . In one case, there was a relapse after 4  weeks. CONCLUSIONS: Preoperative identification of a CSF leak with MRI was positive in only one case. In all other cases, a post-myelography CT had to be performed. In all cases, the preoperative symptoms improved after surgery. Surgical treatment is an effective treatment of spontaneous @entity5173 in cases of refractory symptoms after failed conservative or interventional treatment.
