Tomas Dobrocky1,2, Levin Häni3, Roman Rohner4, Mattia Branca5, Pasquale Mordasini4, Sara Pilgram-Pastor4, Johannes Kaesmacher4, Alessandro Cianfoni6, Ralph T Schär3, Jan Gralla4, Andreas Raabe3, Christian Ulrich3, Jürgen Beck3,7, Eike I Piechowiak4. 1. Department of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital Bern, Freiburgstraße 8, 3010, Bern, Switzerland. tomas.dobrocky@insel.ch. 2. Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany. tomas.dobrocky@insel.ch. 3. Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. 4. Department of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital Bern, Freiburgstraße 8, 3010, Bern, Switzerland. 5. Clinical Trial Unit, University of Bern, Bern, Switzerland. 6. Department of Neuroradiology, Neurocenter of Italian Switzerland, Lugano, Switzerland. 7. Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany.
Abstract
BACKGROUND: Spontaneous intracranial hypotension (SIH) is a debilitating condition requiring effective treatment; however, objective data on treatment response are scarce. PURPOSE: To assess the suitability of the brain MRI-based SIH score (bSIH) for monitoring treatment success in SIH patients with a proven spinal cerebrospinal fluid (CSF) leak after microsurgical closure of the underlying dural breach. METHODS: This retrospective cohort study included consecutive SIH patients with a proven spinal CSF leak, investigated at dedicated referral centre January 2012 to March 2020. The bSIH score integrates 6 imaging findings; 3 major (2 points) and 3 minor (1 point), and ranges from 0 to 9, with 0 indicating low and 9 high probability of spinal CSF loss. The score was calculated using brain magnetic resonance imaging (MRI) before and after surgical treatment of the underlying CSF leak. Headache intensity was registered on a numeric rating scale (NRS) (range 0-10). RESULTS: In this study 52 SIH patients, 35 (67%) female, mean age 45.3 years, with a proven spinal CSF leak were included. The mean bSIH score decreased significantly from baseline to after surgical closure of the underlying dural breach (6.9 vs. 1.3, P < 0.001). A decrease in the NRS score was reported (8.6 vs. 1.2, P < 0.001). CONCLUSION: The bSIH score is a simple tool which may serve to monitor treatment success in SIH patients after surgical closure of the underlying spinal dural leak. Its decrease after surgical closure of the underlying spinal dural breach indicates restoration of an equilibrium within the CSF compartment.
BACKGROUND: Spontaneous intracranial hypotension (SIH) is a debilitating condition requiring effective treatment; however, objective data on treatment response are scarce. PURPOSE: To assess the suitability of the brain MRI-based SIH score (bSIH) for monitoring treatment success in SIH patients with a proven spinal cerebrospinal fluid (CSF) leak after microsurgical closure of the underlying dural breach. METHODS: This retrospective cohort study included consecutive SIH patients with a proven spinal CSF leak, investigated at dedicated referral centre January 2012 to March 2020. The bSIH score integrates 6 imaging findings; 3 major (2 points) and 3 minor (1 point), and ranges from 0 to 9, with 0 indicating low and 9 high probability of spinal CSF loss. The score was calculated using brain magnetic resonance imaging (MRI) before and after surgical treatment of the underlying CSF leak. Headache intensity was registered on a numeric rating scale (NRS) (range 0-10). RESULTS: In this study 52 SIH patients, 35 (67%) female, mean age 45.3 years, with a proven spinal CSF leak were included. The mean bSIH score decreased significantly from baseline to after surgical closure of the underlying dural breach (6.9 vs. 1.3, P < 0.001). A decrease in the NRS score was reported (8.6 vs. 1.2, P < 0.001). CONCLUSION: The bSIH score is a simple tool which may serve to monitor treatment success in SIH patients after surgical closure of the underlying spinal dural leak. Its decrease after surgical closure of the underlying spinal dural breach indicates restoration of an equilibrium within the CSF compartment.