Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension
CSF loss in spontaneous intracranial hypotension disrupts a well-regulated equilibrium. We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach. In total, 19...
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| Veröffentlicht in: | American journal of neuroradiology : AJNR 2020-11, Vol.41 (11), p.2055-2061 |
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| creator | Dobrocky, T Rebsamen, M Rummel, C Häni, L Mordasini, P Raabe, A Ulrich, C T Gralla, J Piechowiak, E I Beck, J |
| description | CSF loss in spontaneous intracranial hypotension disrupts a well-regulated equilibrium. We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach.
In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.
Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL; |
| doi_str_mv | 10.3174/ajnr.A6782 |
| format | Article |
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In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.
Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL;
< .001). The change was apparent in the early follow-up (mean, 4 days). No significant change in mean total brain volume was observed (1136.9 versus 1133.1 mL,
= .58). The mean spontaneous intracranial hypotension score decreased from 6.9 ± 1.5 at baseline to 2.9 ± 1.5 postoperatively.
Our study demonstrated a substantial increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A6782</identifier><identifier>PMID: 33177057</identifier><language>eng</language><publisher>United States: American Society of Neuroradiology</publisher><subject>Adult ; Adult Brain ; Aged ; Cerebrospinal Fluid - diagnostic imaging ; Cerebrospinal Fluid Leak - complications ; Cerebrospinal Fluid Leak - diagnostic imaging ; Cerebrospinal Fluid Leak - surgery ; Fellows' Journal Club ; Female ; Functional ; Humans ; Intracranial Hypotension - diagnostic imaging ; Intracranial Hypotension - etiology ; Intracranial Hypotension - surgery ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Neuroimaging - methods</subject><ispartof>American journal of neuroradiology : AJNR, 2020-11, Vol.41 (11), p.2055-2061</ispartof><rights>2020 by American Journal of Neuroradiology.</rights><rights>2020 by American Journal of Neuroradiology 2020 American Journal of Neuroradiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-b2fca406faa41914a214630f3dc95b00540ca43409f76ef3316140d356845f253</citedby><cites>FETCH-LOGICAL-c378t-b2fca406faa41914a214630f3dc95b00540ca43409f76ef3316140d356845f253</cites><orcidid>0000-0002-7687-6098 ; 0000-0002-6167-3343 ; 0000-0003-2345-7938 ; 0000-0001-5609-0998 ; 0000-0003-1953-9033 ; 0000-0003-1712-4168 ; 0000-0002-3886-466X ; 0000-0001-7892-7138 ; 0000-0002-8441-1485 ; 0000-0002-4636-8623</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658827/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658827/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33177057$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dobrocky, T</creatorcontrib><creatorcontrib>Rebsamen, M</creatorcontrib><creatorcontrib>Rummel, C</creatorcontrib><creatorcontrib>Häni, L</creatorcontrib><creatorcontrib>Mordasini, P</creatorcontrib><creatorcontrib>Raabe, A</creatorcontrib><creatorcontrib>Ulrich, C T</creatorcontrib><creatorcontrib>Gralla, J</creatorcontrib><creatorcontrib>Piechowiak, E I</creatorcontrib><creatorcontrib>Beck, J</creatorcontrib><title>Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>CSF loss in spontaneous intracranial hypotension disrupts a well-regulated equilibrium. We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach.
In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.
Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL;
< .001). The change was apparent in the early follow-up (mean, 4 days). No significant change in mean total brain volume was observed (1136.9 versus 1133.1 mL,
= .58). The mean spontaneous intracranial hypotension score decreased from 6.9 ± 1.5 at baseline to 2.9 ± 1.5 postoperatively.
Our study demonstrated a substantial increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.</description><subject>Adult</subject><subject>Adult Brain</subject><subject>Aged</subject><subject>Cerebrospinal Fluid - diagnostic imaging</subject><subject>Cerebrospinal Fluid Leak - complications</subject><subject>Cerebrospinal Fluid Leak - diagnostic imaging</subject><subject>Cerebrospinal Fluid Leak - surgery</subject><subject>Fellows' Journal Club</subject><subject>Female</subject><subject>Functional</subject><subject>Humans</subject><subject>Intracranial Hypotension - diagnostic imaging</subject><subject>Intracranial Hypotension - etiology</subject><subject>Intracranial Hypotension - surgery</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuroimaging - methods</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkd1uEzEQhS0EoqFwwwMgXyKkbe313y4XSFWgtCIVSIGKO2vi2I3Lxk5tL6hPw6vWSdoKbmzJ882ZOT4IvabkiFHFj-E6pKMTqbr2CZrQnsmmF_3Pp2hCaC8aSUl3gF7kfE0IEb1qn6MDVvsUEWqC_l7EkGLzxQ6Dt_jsdhPLymaf3-PzYJKFbHF0-NKGkrwZB0h4Oj_Fl3EY1xaDKzbh-ZiuvIEBT4eYx7RrADzf-FDfPo6pnjMLv7AP-BsUX6Uy_uPLqiIxFAg2jrlOKwlMguArvlvDhuxjeImeORiyfXV_H6Ifp5--T8-a2dfP59OTWWOY6kqzaJ0BTqQD4LSnHFrKJSOOLU0vFtU3J7XOOOmdktZV_5JysmRCdly4VrBD9GGvuxkXa7s0W8Mw6E3ya0i3OoLX_1eCX-mr-FsrKbquVVXg7b1AijejzUWvfTb1W_cGdcslIXVYSyv6bo-aFHNO1j2OoURvE9XbRPUu0Qq_-XexR_QhQnYHLhmf2g</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Dobrocky, T</creator><creator>Rebsamen, M</creator><creator>Rummel, C</creator><creator>Häni, L</creator><creator>Mordasini, P</creator><creator>Raabe, A</creator><creator>Ulrich, C T</creator><creator>Gralla, J</creator><creator>Piechowiak, E I</creator><creator>Beck, J</creator><general>American Society of Neuroradiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7687-6098</orcidid><orcidid>https://orcid.org/0000-0002-6167-3343</orcidid><orcidid>https://orcid.org/0000-0003-2345-7938</orcidid><orcidid>https://orcid.org/0000-0001-5609-0998</orcidid><orcidid>https://orcid.org/0000-0003-1953-9033</orcidid><orcidid>https://orcid.org/0000-0003-1712-4168</orcidid><orcidid>https://orcid.org/0000-0002-3886-466X</orcidid><orcidid>https://orcid.org/0000-0001-7892-7138</orcidid><orcidid>https://orcid.org/0000-0002-8441-1485</orcidid><orcidid>https://orcid.org/0000-0002-4636-8623</orcidid></search><sort><creationdate>202011</creationdate><title>Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension</title><author>Dobrocky, T ; 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We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach.
In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.
Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL;
< .001). The change was apparent in the early follow-up (mean, 4 days). No significant change in mean total brain volume was observed (1136.9 versus 1133.1 mL,
= .58). The mean spontaneous intracranial hypotension score decreased from 6.9 ± 1.5 at baseline to 2.9 ± 1.5 postoperatively.
Our study demonstrated a substantial increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.</abstract><cop>United States</cop><pub>American Society of Neuroradiology</pub><pmid>33177057</pmid><doi>10.3174/ajnr.A6782</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7687-6098</orcidid><orcidid>https://orcid.org/0000-0002-6167-3343</orcidid><orcidid>https://orcid.org/0000-0003-2345-7938</orcidid><orcidid>https://orcid.org/0000-0001-5609-0998</orcidid><orcidid>https://orcid.org/0000-0003-1953-9033</orcidid><orcidid>https://orcid.org/0000-0003-1712-4168</orcidid><orcidid>https://orcid.org/0000-0002-3886-466X</orcidid><orcidid>https://orcid.org/0000-0001-7892-7138</orcidid><orcidid>https://orcid.org/0000-0002-8441-1485</orcidid><orcidid>https://orcid.org/0000-0002-4636-8623</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Adult Brain Aged Cerebrospinal Fluid - diagnostic imaging Cerebrospinal Fluid Leak - complications Cerebrospinal Fluid Leak - diagnostic imaging Cerebrospinal Fluid Leak - surgery Fellows' Journal Club Female Functional Humans Intracranial Hypotension - diagnostic imaging Intracranial Hypotension - etiology Intracranial Hypotension - surgery Magnetic Resonance Imaging - methods Male Middle Aged Neuroimaging - methods |
| title | Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension |
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