• Elena Beretta, Andrea Franzini, Roberto Cordella, Vittoria Nazzi, Laura Grazia Valentini, and Angelo Franzini.
• Department of Neurosurgery Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy. Electronic address: lamboqantum@gmail.com.
• World Neurosurg. 2017 Nov 1; 107: 1053.e7-1053.e10.

BackgroundSecondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific.Case DescriptionA 37-year-old woman developed secondary intracranial hypotension caused by lumbosacral iatrogenic dural ectasia following detethering surgery. An orthostatic headache was the mainstay of her clinical picture, and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time (<1 month). Altered compliance of the dural spinal sac was suspected. Therefore thecal sac remodeling by placing autologous fat at the level of the dural ectasia was performed, improving the symptoms for 2 years.ConclusionVolumetric reduction of the epidural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the dural sac is hypothesized.Copyright © 2017 Elsevier Inc. All rights reserved.

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