高流量硬脊膜脑脊液漏致自发性低颅压6例临床分析

Spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks:analysis of 6 patients

目的分析6例高流量硬脊膜脑脊液漏致自发性低颅压患者的临床特点。方法回顾性总结2021年2月至2022年4月首都医科大学宣武医院诊治的6例高流量硬脊膜脑脊液漏致自发性低颅压患者的临床资料,对其临床表现、辅助检查、治疗及转归进行分析。结果6例患者均表现为体位性头痛,头颅磁共振成像均显示硬脑膜强化和脑下坠,水成像均显示长节段硬脊膜外积液,经动态造影证实为高流量脑脊液漏,活动性漏口均位于上胸段。经保守治疗后2例患者头痛缓解,4例患者仍有残余头痛症状,经1~2次靶向硬膜外血贴治疗后最终头痛缓解。结论依据高流量硬脊膜脑脊液漏所致自发性低颅压患者的典型体位性头痛表现、头颅磁共振成像和水成像结果诊断并不困难,但活动性漏口的准确定位需结合动态造影检查,保守治疗效果差,靶向硬膜外血贴治疗效果良好。

Objective To analyze the clinical features of 6 patients with spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks.Methods The clinical characteristics,auxiliary examinations,treatment,and outcomes in 6 patients of spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks enrolled in the Xuanwu Hospital,Capital Medical University from February 2021 to April 2022 were retrospectively reviewed.Results All the 6 patients had orthostatic headaches.Brain magnetic resonance imaging showed dural enhancement and brain sagging and magnetic resonance myelography showed longitudinal extradural collection in all the patients.The high-flow spinal cerebrospinal fluid leaks were demonstrated in upper thoracic segments by the dynamic myelography.The headache disappeared after conservative treatment in 2 patients and treatment with targeted epidural blood patch in 4 patients.Conclusions The diagnosis of spontaneous intracranial hypotension caused by high-flow spinal cerebrospinal fluid leaks with typical orthostatic headache and brain magnetic resonance imaging and myelography findings is not difficult.However,the localization of the site of high-flow spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension depends on the dynamic myelography.Targeted epidural blood patch is effective,but conservative treatment does not always work.