Minim Invasive Neurosurg 2010; 53(1): 15-20
DOI: 10.1055/s-0030-1247552
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostics and Treatment of Spontaneous Intracranial Hypotension

U. Schick1 , 2 , C. Musahl1 , K. Papke3
  • 1Clinic of Neurological Surgery, Wedau Kliniken Duisburg, Duisburg, Germany
  • 2Clinic of Neurological Surgery, University of Heidelberg, Heidelberg, Germany
  • 3Department of Neuroradiology, Wedau Kliniken Duisburg, Duisburg, Germany
Further Information

Publication History

Publication Date:
07 April 2010 (online)


Objective: Intracranial hypotension is a frequently misdiagnosed syndrome which is caused by reduced intracranial cerebrospinal fluid (CSF) pressure due to spontaneous spinal CSF leakage. We present our series of intracranial hypotension regarding especially the required diagnostic imaging and the treatment.

Methods: A retrospective analysis was performed on 8 patients (5 males, 3 females, mean age 49 years) with postural and non-postural headache due to spinal CSF collection.

Results: Cranial MRI showed diffuse pachymeningeal gadolinium enhancement in all cases. CSF leakage detected by gadolinium-enhanced MR cisternography could be either diffuse (n=5) or precisely located around a dural tear (n=3). All but one leakages were located at the thoracic spine. In 6 patients 40–65 mL of blood were injected through epidurally placed drainages. In 1 patient, a dural tear was sealed with fibrin glue and fat. One patient refused surgical intervention. One epidural haematoma had to be revised. 5 of 7 patients showed excellent results.

Conclusion: Gadolinium-enhanced MR cisternography best revealed CSF leaks. In the majority of patients with spontaneous intracranial hypotension, complete recovery may be achieved via a midthoracic epidural blood patch with minimal complications.


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U. SchickMD, PhD 

Clinic of Neurological Surgery

University of Heidelberg

Im Neuenheimer Feld 400

69120 Heidelberg


Phone: +49/6221/56 6301

Fax: +49/6221/56 5534