Clinical features of cerebrospinal fluid leakage after a confirmed diagnosis by CT myelography

Abstract

We present the clinical features of 58 cases in which an epidural blood patch (EBP) was performed after a diagnosis of cerebrospinal fluid leakage (CSFL) was confirmed by CT myelography (CTM). From December 2004 to February 2016, we retrospectively evaluated 58 cases of CSFL in terms of epidemiology, presence of orthostatic headache, subarachnoid hematoma, diffuse pachymeningeal gadolinium enhancement, number of EBPs required, amount of autologous blood injected into the epidural space, and whether patients were treated with fluoroscopy-guided EBP. CSFL occurs predominantly in women and is most common in patients in their late thirties. In this study, 79.3％ (46/58) of CSFL patients developed orthostatic headache. Subdural hematoma was found in 34.5％ (20/58) of patients and 13.8％ (8/58) needed a burr hole. At most, patients required 6 EBPs until their symptoms diminished (the median was two EBPs). In fact, 74.1％ (43/58) of patients completely recovered after two EBPs. The results of this report suggest that orthostatic headache and diffuse pachymeningeal gadolinium enhancement are common in CSFL patients, and fluoroscopy-guided EBP is an effective treatment method for CSFL.