Fichtner, Jens and Ulrich, Christian T. and Fung, Christian and Cipriani, Debora and Gralla, Jan and Piechowiak, Eike Immo and Schlachetzki, Felix and Z'Graggen, Werner J. and Raabe, Andreas and Beck, Juergen (2019) Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension - a consecutive cohort study. CEPHALALGIA, 39 (2). pp. 306-315. ISSN 0333-1024, 1468-2982
Full text not available from this repository. (Request a copy)Abstract
Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.080.66mm before to 5.36 +/- 0.53mm after surgery (p=0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (-0.36 +/- 0.32mm) to after surgery (0.00 +/- 0.19mm, p<0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DIAGNOSTIC-CRITERIA; PRESSURE; ULTRASOUND; HYPERTENSION; HEADACHE; LEAKS; Spontaneous intracranial hypotension; orthostatic headaches; spinal CSF leak; spinal microsurgery; optic nerve sheath diameter; transorbital sonography; gravitational challenge |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Apr 2020 05:19 |
| Last Modified: | 20 Apr 2020 05:19 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27618 |
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