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Brain Spontaneous Intracranial Hypotension Score for Treatment Monitoring After Surgical Closure of the Underlying Spinal Dural Leak

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Abstract

Background

Spontaneous intracranial hypotension (SIH) is a debilitating condition requiring effective treatment; however, objective data on treatment response are scarce.

Purpose

To assess the suitability of the brain MRI-based SIH score (bSIH) for monitoring treatment success in SIH patients with a proven spinal cerebrospinal fluid (CSF) leak after microsurgical closure of the underlying dural breach.

Methods

This retrospective cohort study included consecutive SIH patients with a proven spinal CSF leak, investigated at dedicated referral centre January 2012 to March 2020. The bSIH score integrates 6 imaging findings; 3 major (2 points) and 3 minor (1 point), and ranges from 0 to 9, with 0 indicating low and 9 high probability of spinal CSF loss. The score was calculated using brain magnetic resonance imaging (MRI) before and after surgical treatment of the underlying CSF leak. Headache intensity was registered on a numeric rating scale (NRS) (range 0–10).

Results

In this study 52 SIH patients, 35 (67%) female, mean age 45.3 years, with a proven spinal CSF leak were included. The mean bSIH score decreased significantly from baseline to after surgical closure of the underlying dural breach (6.9 vs. 1.3, P < 0.001). A decrease in the NRS score was reported (8.6 vs. 1.2, P < 0.001).

Conclusion

The bSIH score is a simple tool which may serve to monitor treatment success in SIH patients after surgical closure of the underlying spinal dural leak. Its decrease after surgical closure of the underlying spinal dural breach indicates restoration of an equilibrium within the CSF compartment.

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Abbreviations

bSIH score:

Brain spontaneous intracranial hypotension score

CSF:

Cerebrospinal fluid

CSFVF:

CSF venous fistula

CT:

Computed tomography

FLAIR:

Fluid-attenuated inversion recovery

IQR:

Interquartile range

MPD:

Mamillopontine distance

MPR:

Multiplanar reconstruction

MRI:

Magnetic resonance imaging

NRS:

Numeric rating scale

ntEBP:

Non-targeted epidural blood patch

SD:

Standard deviation

SE:

Spin echo

SIH:

Spontaneous intracranial hypotension

SSS:

Superior sagittal sinus

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital Bern, Freiburgstraße 8, 3010, Bern, Switzerland

    Tomas Dobrocky, Roman Rohner, Pasquale Mordasini, Sara Pilgram-Pastor, Johannes Kaesmacher, Jan Gralla & Eike I. Piechowiak

  2. Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

    Levin Häni, Ralph T. Schär, Andreas Raabe, Christian Ulrich & Jürgen Beck

  3. Clinical Trial Unit, University of Bern, Bern, Switzerland

    Mattia Branca

  4. Department of Neuroradiology, Neurocenter of Italian Switzerland, Lugano, Switzerland

    Alessandro Cianfoni

  5. Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany

    Tomas Dobrocky & Jürgen Beck

Authors
  1. Tomas Dobrocky
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  2. Levin Häni
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  3. Roman Rohner
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  4. Mattia Branca
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  5. Pasquale Mordasini
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  6. Sara Pilgram-Pastor
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  7. Johannes Kaesmacher
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  8. Alessandro Cianfoni
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  9. Ralph T. Schär
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  10. Jan Gralla
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  11. Andreas Raabe
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  12. Christian Ulrich
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  13. Jürgen Beck
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  14. Eike I. Piechowiak
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Corresponding author

Correspondence to Tomas Dobrocky.

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Conflict of interest

T. Dobrocky, L. Häni, R. Rohner, M. Branca, P. Mordasini, S. Pilgram-Pastor, J. Kaesmacher, A. Cianfoni, R.T. Schär,J. Gralla, A. Raabe, C. Ulrich, J. Beck and E.I. Piechowiak declare that they have no competing interests.

Additional information

The authors Tomas Dobrocky and Levin Häni contributed equally to the manuscript.

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Dobrocky, T., Häni, L., Rohner, R. et al. Brain Spontaneous Intracranial Hypotension Score for Treatment Monitoring After Surgical Closure of the Underlying Spinal Dural Leak. Clin Neuroradiol 32, 231–238 (2022). https://doi.org/10.1007/s00062-021-01124-z

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  • DOI: https://doi.org/10.1007/s00062-021-01124-z

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