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Management of Intracranial Hypotension and Cerebrospinal Fluid Leaks

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Abstract

Intracranial hypotension and cerebrospinal fluid (CSF) leaks may occur secondary to numerous pathologies, including trauma, iatrogenic injury, or even in a spontaneous manner. A diagnostic hallmark of intracranial hypotension is the presence of low CSF volume rather than low CSF pressure. As such, intracranial hypotension may occur in the setting of low, normal, or elevated intracranial pressure. The diagnostic evaluation of this pathology, in addition to localization of a potential leak, can be challenging, requiring numerous noninvasive and invasive imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), lumbar puncture, myelography, or cisternography. While medical management can provide symptomatic relief, definitive treatment of the source of the pathology depends on the etiology of the CSF leak. Depending on the source and localization of the CSF leak, less invasive means of CSF diversion may be sufficient, or patients may require definitive repair of the CSF fistula. Ultimately, proper evaluation and correct diagnosis of the pathology driving the CSF leak frame the paradigm for treatment of intracranial hypotension.

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Authors and Affiliations

  1. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    David L. Dornbos III, Nathaniel Toop, Ammar Shaikhouni & John M. McGregor

  2. Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    H. Wayne Slone

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  1. Department of Neurological Surgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA

    David D. Limbrick Jr.

  2. Nationwide Children’s Hospital, Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA

    Jeffrey R. Leonard

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Dornbos, D.L., Toop, N., Shaikhouni, A., Slone, H.W., McGregor, J.M. (2019). Management of Intracranial Hypotension and Cerebrospinal Fluid Leaks. In: Limbrick Jr., D., Leonard, J. (eds) Cerebrospinal Fluid Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-97928-1_15

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  • DOI: https://doi.org/10.1007/978-3-319-97928-1_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97927-4

  • Online ISBN: 978-3-319-97928-1

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