Conflict of Interest: None
A Novel Technique for Treatment of Intractable Spontaneous Intracranial Hypotension: Lumbar Dural Reduction Surgery
Version of Record online: 15 MAY 2009
© 2009 the Author. Journal compilation © 2009 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 7, pages 1047–1051, July/August 2009
How to Cite
Schievink, W. I. (2009), A Novel Technique for Treatment of Intractable Spontaneous Intracranial Hypotension: Lumbar Dural Reduction Surgery. Headache: The Journal of Head and Face Pain, 49: 1047–1051. doi: 10.1111/j.1526-4610.2009.01450.x
- Issue online: 6 JUL 2009
- Version of Record online: 15 MAY 2009
- Accepted for publication March 11, 2009.
- cerebrospinal fluid;
- intracranial pressure;
- spinal cerebrospinal fluid leak;
- spinal dura
Background and Objective.— Spontaneous intracranial hypotension has become a well-described cause of headache particularly among young and middle-aged individuals. Treatment of the underlying spinal cerebrospinal fluid (CSF) leak is effective in relieving symptoms in the vast majority of patients but symptoms may become refractory. The author describes a novel surgical technique to treat intractable spontaneous intracranial hypotension.
Methods.— A lumbar laminectomy is performed, a strip of dura is resected, and the dural defect is closed. The resulting decrease in lumbar CSF volume is believed to increase intracranial CSF volume and pressure.
Results.— The technique was utilized in a patient who suffered with intractable positional headaches because of a spinal CSF leak for 6 years in spite of numerous surgical and nonsurgical therapies. Significant improvement of symptoms was sustained during a 1-year period of follow-up.
Conclusion.— Dural reduction surgery may be considered in carefully selected patients with intracranial hypotension.