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Management of Intracranial Hypotension and Cerebrospinal Fluid Leaks

  • David L. DornbosIII
  • Nathaniel Toop
  • Ammar Shaikhouni
  • H. Wayne Slone
  • John M. McGregor
Chapter

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.

Keywords

Idiopathic intracranial hypertension Cerebrospinal fluid (CSF) leak Idiopathic intracranial hypotension Blood patch Pseudotumor cerebri Acquired Chiari type I malformation CSF hypotension 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David L. DornbosIII
    • 1
  • Nathaniel Toop
    • 1
  • Ammar Shaikhouni
    • 1
  • H. Wayne Slone
    • 2
  • John M. McGregor
    • 1
  1. 1.Department of Neurological SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusUSA

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