Brain Spontaneous Intracranial Hypotension Score for Treatment Monitoring After Surgical Closure of the Underlying Spinal Dural Leak

Dobrocky, Tomas; Häni, Levin; Rohner, Roman; Branca, Mattia; Mordasini, Pasquale; Pilgram‐Pastor, Sara; Kaesmacher, Johannes; Cianfoni, Alessandro; Schär, Ralph T.; Gralla, Jan; Raabe, Andreas; Beck, Jürgen; Piechowiak, Eike Immo

doi:10.1007/s00062-021-01124-z

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…Our improved imaging scores were also in keeping with the improved clinical and myelographic findings. The Bern SIH score assessment was initially developed as a predictive model for CSF leak, but it has been used to characterize brain MRIs after treatment 6,16 . While this posttreatment assessment is probably an accurate characterization of CSF leak improvement, additional studies are needed to validate these findings.…”

Section: Discussionmentioning

confidence: 99%

“…The Bern SIH score assessment was initially developed as a predictive model for CSF leak, but it has been used to characterize brain MRIs after treatment. 6,16 While this posttreatment assessment is probably an accurate characterization of CSF leak improvement, additional studies are needed to validate these findings. become more familiar with the technique, we have witnessed that targeting the needle at the meningeal diverticulum-vein junction is one of the keys to successful treatment.…”

Section: Imaging Outcome Measuresmentioning

confidence: 92%

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Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

2022

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Objective: To assess headache response and patient perception of improvement after computed tomography (CT)-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas (CVFs) in a large sample size and with a long clinical follow-up.Background: CVFs are an increasingly identified type of spinal leak in patients with spontaneous intracranial hypotension (SIH), and CT-guided fibrin glue occlusion has been introduced as a treatment option in a prior small series.Methods: Retrospective case series review of medical records from a single institution was performed for all patients with CVFs that were treated with CT-guided fibrin glue occlusion between August 2018 and April 2022 in an outpatient or inpatient setting. Pre-and posttreatment Headache Impact Tests (HIT-6) were administered to patients, and a change in scores was evaluated. In some patients, pretreatment HIT-6 tests were not obtained prior to the fibrin glue procedure, and the patient was asked to fill out the pretreatment test based on personal recall of their symptoms prior to treatment. Patients completed a Patient Global Impression of Change (PGIC) scale after treatment. Pre-and posttreatment brain imaging was compared using Bern SIH scores.Results: Thirty-five patients (19 females, 16 males; mean age 60 years) with CVFs treated with CT-guided fibrin glue occlusion met the inclusion criteria. Mean pretreatment and posttreatment HIT-6 scores were 64.7 ± 10.2 and 43.4 ± 9.9 (p < 0.001), respectively. The posttreatment HIT-6 questionnaires were completed on average 10.3 months after treatment, and 20 patients filled out the pretreatment HIT-6 form after their treatment. The mean PGIC score was 6.1 ± 1.3. Mean pretreatment and posttreatment Bern SIH scores were 5.9 ± 2.5 and 1.5 ± 1.5 (p < 0.001), respectively. Conclusions:We report a large series of patients who underwent CT-guided fibrin glue occlusion of CVFs. We showed that headache scores decreased after treatment, and the majority of patients had high PGIC scores. Posttreatment brain MRIs also showed improved Bern SIH scores.

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Section: Discussionmentioning

confidence: 99%

Section: Imaging Outcome Measuresmentioning

confidence: 92%

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

2022

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“…Neuroimaging is crucial in diagnosing, classification, and monitoring SIH (Schievink, 2016 ; Dobrocky et al., 2022 ), especially as low OP is an unreliable marker. Various imaging tools are used to diagnose and localize CSF leak.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leak, with orthostatic headache being its most frequent symptom (Schievink, 2006 ). Delay or misdiagnosis of SIH is not uncommon (Callen et al., 2023 ; Dobrocky, Nicholson et al., 2022 ). In this setting, different tools are evolving to facilitate its diagnosis and detecting of CSF leak.…”

Section: Introductionmentioning

confidence: 99%

Negative correlation between the Bern score and opening pressure in myelography positive spontaneous intracranial hypotension

Zhang,

et al. 2024

Brain and Behavior

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ObjectiveThe Bern score is based on brain magnetic resonance imaging (MRI) to predict the probability of cerebrospinal fluid (CSF) leak in spontaneous intracranial hypotension (SIH). The aim of this study is to investigate the association between lumbar puncture opening pressure (OP) and the Bern score.MethodsWe retrospectively reviewed OP measurement records and neuroimaging of patients with SIH in our center. The Bern score and its components were measured based on contrast‐enhanced brain MRI. The associations between OP and the Bern score, as well as its components, were analyzed. Patients were divided as low‐pressure (LP) group (OP < 60 mmH2O) and not‐low‐pressure (NLP) group (OP ≥ 60 mmH2O). Differences in terms of the Bern score and its components were compared between the two groups.ResultsSeventy‐one (mean age 40.4 ± 10.6 years) patients with myelography confirmed CSF leak were included in this study. The mean disease duration when performed brain MRI was 32 ± 29 days, with a mean Bern score of 5.1 ± 2.7 and a mean OP of 68.6 ± 60.3 mmH2O. There are statistically negative correlations between OP and the Bern score (p < .001), as well as suprasellar cistern (p < .01) and prepontine cistern (p < .01). The presence of venous engorgement (p < .01) and pachymeningeal enhancement (p < .001) were significantly associated with OP. The LP groups have higher Bern scores than the NLP group (5.9 ± 2.5 vs. 4.2 ± 2.6, p = .004).ConclusionsA higher Bern score is indicative of not only an increased likelihood of a CSF leak but also a greater probability of low OP in patients with SIH. For patients with a Bern score ≥5 and positive heavily T2‐weighted MR myelography findings, epidural blood patch is reasonable before invasive myelography.

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“…3,13 Surgical and endovascular repair of the leak or CSF-venous fistula appear to be promising, but longterm outcomes are not well studied. 4,[14][15][16][17] All of these therapeutic procedures can cause rebound intracranial hypertension of variable duration, requiring additional treatment. 18,19 Thus, related to its low incidence and lack of a gold standard diagnostic test, SIH may be difficult to diagnose and treat.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks

Liaw,

McCreary,

Friedman

2023

Neurology

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Background and Objectives: Spontaneous intracranial hypotension (SIH) is a debilitating condition typically producing orthostatic headache limiting upright time. SIH is often difficult to diagnose and treat, negatively affecting quality-of-life (QoL) in patients with the disorder. We studied QOL in confirmed and suspected SIH patients using standardized instruments, including suicidality. Methods: We performed a cross-sectional survey of adult patients with confirmed and clinically suspected SIH evaluated in our Headache and Facial Pain Program from 2016 to 2022. Using an online data collection tool (REDCap V 11.2.2), participants completed validated questionnaires assessing general well-being (SF-36), depression (PHQ-9), general anxiety disorder-7 (GAD-7), spiritual well-being during chronic therapy (FACIT-Sp-12) and headache impact (HIT-6). Subsequently, we interviewed willing participants to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) assessing suicidal behavior and ideation. Results: 234 patients met inclusion criteria and were invited to participate in the study and 95 (59 confirmed and 36 clinically suspected) completed the questionnaires. The cohort’s average age was 51.1 years (SD: 15.5), predominantly female (69.5%), White (91.6%), and married (69.5%). Three-quarters (74.5%) scored within the most severe headache category (HIT-6). SF-36 scores were significantly inferior (p < .0001) to the general population, and lower than reported values for patients with multiple sclerosis and idiopathic intracranial hypertension. Almost half (49.1%) of respondents scored in the moderate depression range or worse (>10) and 25.4% scored with moderate anxiety or worse (>10). FACIT-Sp-12 scores were significantly worse (p < 0.0001) in symptomatic participants than in the validation cohorts of AIDS and cancer patients. Of the 67 respondents who completed the C-SSRS, over half (64.2%) endorsed a wish to be dead, and 22.4% had demonstrated suicidal behavior. Symptom-free SIH patients (n = 22) scored significantly better than symptomatic patients, comparable to the general population. Conclusion: Based on our single-center cohort, SIH is associated with severe headache pain and high rates of depression, anxiety, and disability, affecting basic activities of daily living. Individuals with confirmed and suspected spinal CSF leaks scored similarly on these measures including suicidality. Outcomes were comparable to the general population following successful treatment or spontaneous remission. Improved identification and treatment of SIH are imperative to improve patients’ QoL.

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Brain Spontaneous Intracranial Hypotension Score for Treatment Monitoring After Surgical Closure of the Underlying Spinal Dural Leak

Cited by 11 publications

References 18 publications

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

Negative correlation between the Bern score and opening pressure in myelography positive spontaneous intracranial hypotension

Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks

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