ocleft.blogg.se - Leaking spinal fluid

Leaking spinal fluid Patch#
Leaking spinal fluid crack#

In both cases, the mini-leak must be searched for carefully and with great effort it is almost always "hidden". Two specialized teams or physicians are needed: for precise neuroradiological diagnostics and for surgery.

A second or third diagnostic round may also be necessary in our clinic, with multiple MRIs and myelographies to diagnose or rule out the disease. If symptoms persist, it is imperative to continue looking for the leak.

Many clinics perform an evaluation without finding the leak.

After lumbar puncture, the chance of spontaneous healing is almost 100%, but in the case of dura tear because of a mini-spur, it is significantly lower. However, if closure of the dural leak does not occur relatively quickly (spontaneously or by surgery), or if the cause is a dural slit due to a microspur, a chronic clinical picture may develop in which the symptoms change, spread, and lead to complaints that are atypical and often wrongly classified as "psychogenic." Severe symptoms can be expected, ranging from severe impairment to practical bedriddenness.

CSF leaks are often benign and have a high spontaneous healing rate.

The specific methods of diagnosis and the staging scheme are often not known. Over the last few years, we have therefore been able to gain important insights into the decoding of this rare disease:

Inselspital is one of the three largest centers in Europe in the special field of cerebrospinal fluid leaks.

Leaking spinal fluid Patch#

If relief from symptoms is not achieved even after 2 blood patch treatments, surgical closure of the CSF leak should be performed because otherwise the headache may progress to a chronic stage with increasing involvement of cranial nerves and more severe vegetative symptoms. This minimally invasive procedure is very often successful. In the short term, therefore, a blood patch nearly always improves symptoms, even if it is placed far from the leak. The effect of the blood patch comes not from gluing the hole shut, but from compressing the dural sac, which prevents as much cerebrospinal fluid from flowing from the head into the spinal dural sac when the patient stands up or sits down. The blood patch is usually applied to the lower back at the level of the 3rd/4th lumbar vertebra. In this procedure, the patient's own blood, which was taken from a vein shortly beforehand, is injected into the space around the spinal cord membranes (epidural space). If no spontaneous closure of the CSF fistula occurs through bed rest, the next step is a so-called blood patch.

Bed rest and caffeine (only during the initial stage for a few days).

Dynamic myelo-computed tomography of the target region with special technique *.

Post-myelo computed tomography with early images and late images if necessary.

Dynamic myelography with special tilting table, if necessary intubated as digital subtraction myelography.

Lumbar puncture with opening pressure and computerized infusion test.

Spinal MRI with intrathecal contrast imaging (in selected cases).

Dynamic (standing and lying) ultrasound examination of the optic sheath.

Special sequences of cranial and spinal MRI.

Depending on the findings, individual steps can be skipped or additional examinations can be ordered:

We have developed a special step-by-step diagnostic protocol at Inselspital to answer both questions, which is performed with enormous care and in a highly standardized manner by a specialized and experienced neuroradiologist. In addition, there are so-called "false-localizing signs", i.e. It is precisely at this point that many examinations in other clinics fail, since conventional examinations usually conceal the leak. The most challenging part is actually finding this tiny tear and localizing it to the millimeter throughout the spine. the defect in the dura from which the CSF escapes? The second question is even more important: Where exactly is the CSF fistula located, i.e. In this way, one knows with relative certainty that CSF is really draining. If direct detection is not possible, the diagnosis can be confirmed indirectly using other methods, such as ultrasound of the optic nerve or measurement of the outflow resistance of the CSF. In addition to conventional myelography, a combination with myelo-computed tomography (myelo-CT) is also possible. a radiological contrast image of the spinal canal, is performed. If the findings are negative, a myelography, i.e. This is usually done by magnetic resonance imaging (MRI). This first needs to be confirmed with certainty.

Leaking spinal fluid crack#

The initial question is: Is cerebrospinal fluid actually leaking through a crack in the dura?