Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal fluid leaks

Clinical article

Restricted access

Object

Spontaneous intracranial hypotension is an important cause of headaches and an underlying spinal CSF leak can be demonstrated in most patients. Whether CSF leaks at the level of the skull base can cause spontaneous intracranial hypotension remains a matter of controversy. The authors' aim was to examine the frequency of skull base CSF leaks as the cause of spontaneous intracranial hypotension.

Methods

Demographic, clinical, and radiological data were collected from a consecutive group of patients evaluated for spontaneous intracranial hypotension during a 9-year period.

Results

Among 273 patients who met the diagnostic criteria for spontaneous intracranial hypotension and 42 who did not, not a single instance of CSF leak at the skull base was encountered. Clear nasal drainage was reported by 41 patients, but a diagnosis of CSF rhinorrhea could not be established. Four patients underwent exploratory surgery for presumed CSF rhinorrhea. In addition, the authors treated 3 patients who had a postoperative CSF leak at the skull base following the resection of a cerebellopontine angle tumor and developed orthostatic headaches; spinal imaging, however, demonstrated the presence of a spinal source of CSF leakage in all 3 patients.

Conclusions

There is no evidence for an association between spontaneous intracranial hypotension and CSF leaks at the level of the skull base. Moreover, the authors' study suggests that a spinal source for CSF leakage should even be suspected in patients with orthostatic headaches who have a documented skull base CSF leak.

Article Information

Contributor Notes

Address correspondence to: Wouter I. Schievink, M.D., Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, California 90048. email: schievinkw@cshs.org.Please include this information when citing this paper: published online January 20, 2012; DOI: 10.3171/2011.12.JNS111474.
Headings
References
  • 1

    Eross EDodick DEross M: The Sinus, Allergy and Migraine Study (SAMS). Headache 47:2132242007

  • 2

    Lai THFuh JLWang SJ: Cranial autonomic symptoms in migraine: characteristics and comparison with cluster headache. J Neurol Neurosurg Psychiatry 80:111611192009

    • Search Google Scholar
    • Export Citation
  • 3

    Levine DNRapalino O: The pathophysiology of lumbar puncture headache. J Neurol Sci 192:182001

  • 4

    Matharu MSGoadsby PJTrigeminal autonomic cephalalgias: diagnosis and management. Silberstein SDLipton RBDodick DW: Wolff's Headache and Other Head Pain ed 8New YorkOxford University Press2008. 379430

    • Search Google Scholar
    • Export Citation
  • 5

    Mokri BSchievink WIHeadache associated with abnormalities in intracranial structure or function: low-cerebrospinal-fluid-pressure headache. Silberstein SDLipton RBDodick DW: Wolff's Headache and Other Head Pain ed 8New YorkOxford University Press2008. 513531

    • Search Google Scholar
    • Export Citation
  • 6

    Rozen TD: A history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches. Headache 51:85912011

    • Search Google Scholar
    • Export Citation
  • 7

    Schievink WI: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:228622962006

  • 8

    Schievink WIMaya MM: Frequency of intracranial aneurysms in patients with spontaneous intracranial hypotension. Clinical article. J Neurosurg 115:1131152011

    • Search Google Scholar
    • Export Citation
  • 9

    Schievink WIMaya MMLouy CMoser FGTourje J: Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol 29:8538562008

    • Search Google Scholar
    • Export Citation
  • 10

    Schievink WIPalestrant DMaya MMRappard G: Spontaneous spinal cerebrospinal fluid leak as a cause of coma after craniotomy for clipping of an unruptured intracranial aneurysm. Case report. J Neurosurg 110:5215242009

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 413 333 26
Full Text Views 241 61 4
PDF Downloads 192 54 4
EPUB Downloads 0 0 0
PubMed
Google Scholar