Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

Abstract

The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.

Discovering spontaneous intracranial hypotension after failed middle meningeal artery embolization for subdural hematomas: illustrative cases

“…The definitive treatment seems to be closure of the CSF leak; however, it is hard to justify deferring SDH evacuation if the patient is presenting with mass effect and a large collection. 5 , 9 , 10 , 14 , 15 However, it is important to consider the surgical risks of SDH evacuation with concurrent SIH. Exposure to atmospheric pressure, such as after a decompressive craniectomy for hematoma evacuation, can increase caudal herniation in a CSF hypovolemic brain due to increased downward traction.…”

“…Since SIH is caused by CSF leakage at spinal areas, computed tomography (CT) or magnetic resonance (MR) myelography can be used to detect the site of CSF leakage. 3–5 Kim et al 5 showed that 80% of patients in their study with nontraumatic SDHs had spinal CSF leaks using CT myelography. The management of SDH in SIH remains controversial, with no current consensus on treatment.…”

“…Only addressing the SDH can lead to recurrence and continued symptomatology. [3][4][5][6] Therefore, the differential diagnosis of SIH should be stressed when a patient presents with a nontraumatic SDH or has recurrent SDHs after initial management.…”