• G Albes, H Weng, D Horvath, C Musahl, H Bäzner, and H Henkes.
• Klinik für Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
• Neuroradiology. 2012 Dec 1; 54 (12): 1367-73.

IntroductionThis study aimed to evaluate the diagnostic imaging findings and treatment results of patients with idiopathic intracranial hypotension (IIH) due to cerebrospinal fluid (CSF) leaks.MethodsBetween February 2009 and April 2012, 26 IIH patients (15 men, median age 49 years) presenting with orthostatic headache (n = 20) and/or with spontaneous subdural effusions or subarachnoid hemorrhage (n = 19) were enrolled. Twenty-three patients underwent a whole spine CT and MRI myelography, starting 45 min after the intrathecal injection of 9 cc of iomeprol (Imeron 300 M) and 1 cc of gadobutrolum (Gadovist). Three patients only underwent MR myelography after intrathecal gadobutrolum injection. Adjacent to the level(s) of the detected CSF leak(s) along the nerve roots, 20 cc of fresh venous blood with 0.5 cc Gadovist was injected epidurally (blood patch, BP). The distribution of the BP was visualized by MRI the following day. Treatment results were evaluated clinically and by myelography 2 weeks after the application of the BP. Retreatment was offered to patients with persistent symptoms and continued CSF leakage.ResultsCSF leaks were detected at the cervical (n = 12), thoracic (n = 25), or lumbar (n = 21) spine. In 23 patients, more than one spinal segment was affected. One patient refused treatment. BP were applied in one (n = 9) or several (n = 16) levels. Clinical and/or radiological improvement was achieved after one (n = 16), two (n = 5), three (n = 3), or five (n = 1) BPs.ConclusionCT and MRI myelography allow the reliable detection of spinal CSF leaks. The targeted and eventually repeated epidural BP procedure is a safe and efficacious treatment.

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