Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma

  • An, Sungjae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jeong, Han-Gil (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Seo, Dongwook (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jo, Hyunjun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Si Un (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bang, Jae Seung (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Oh, Chang Wan (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Tackeun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2020.11.23
  • Accepted : 2021.03.26
  • Published : 2022.01.01
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Abstract

Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.

Keywords

References

  1. Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, et al. : Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259 : 449-457, 2014 https://doi.org/10.1097/SLA.0000000000000255
  2. Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, et al. : Middle meningeal artery embolization for chronic subdural hematoma. Radiology 286 : 992-999, 2018 https://doi.org/10.1148/radiol.2017170053
  3. Beck J, Gralla J, Fung C, Ulrich CT, Schucht P, Fichtner J, et al. : Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients. J Neurosurg 121 : 1380-1387, 2014 https://doi.org/10.3171/2014.6.JNS14550
  4. Beck J, Hani L, Ulrich CT, Fung C, Jesse CM, Piechowiak E, et al. : Diagnostic challenges and therapeutic possibilities in spontaneous intracranial hypotension. Clin Transl Neurosci 2 : 2514183X18787371, 2018
  5. Berroir S, Loisel B, Ducros A, Boukobza M, Tzourio C, Valade D, et al. : Early epidural blood patch in spontaneous intracranial hypotension. Neurology 63 : 1950-1951, 2004 https://doi.org/10.1212/01.WNL.0000144339.34733.E9
  6. Busl KM, Prabhakaran S : Predictors of mortality in nontraumatic subdural hematoma. J Neurosurg 119 : 1296-1301, 2013 https://doi.org/10.3171/2013.4.JNS122236
  7. Chen HH, Huang CI, Hseu SS, Lirng JF : Bilateral subdural hematomas caused by spontaneous intracranial hypotension. J Chin Med Assoc 71 : 147-151, 2008 https://doi.org/10.1016/S1726-4901(08)70007-8
  8. Chen YC, Wang YF, Li JY, Chen SP, Lirng JF, Hseu SS, et al. : Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension. Cephalalgia 36 : 225-231, 2016 https://doi.org/10.1177/0333102415585095
  9. Chung SJ, Lee JH, Kim SJ, Kwun BD, Lee MC : Subdural hematoma in spontaneous CSF hypovolemia. Neurology 67 : 1088-1089, 2006 https://doi.org/10.1212/01.wnl.0000237338.44702.61
  10. Dehaene S, Biesemans J, Van Boxem K, Vidts W, Sterken J, Van Zundert J : Post-dural puncture headache evolving to a subdural hematoma: a case report. Pain Pract 21 : 83-87, 2021 https://doi.org/10.1111/papr.12937
  11. Dhillon AK, Rabinstein AA, Wijdicks EF : Coma from worsening spontaneous intracranial hypotension after subdural hematoma evacuation. Neurocrit Care 12 : 390-394, 2010 https://doi.org/10.1007/s12028-009-9323-8
  12. Ferrante E, Arpino I, Citterio A, Savino A : Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the trendelenburg position pre-medicated with acetazolamide. Clin Neurol Neurosurg 111 : 699-702, 2009 https://doi.org/10.1016/j.clineuro.2009.06.001
  13. Ferrante E, Olgiati E, Sangalli V, Rubino F : Early pain relief from orthostatic headache and hearing changes in spontaneous intracranial hypotension after epidural blood patch. Acta Neurol Belg 116 : 503-508, 2016 https://doi.org/10.1007/s13760-016-0617-2
  14. Ferrante E, Trimboli M, Pontrelli G, Rubino F : Early coma awakening after epidural blood patch. J Clin Neurosci 71 : 295-296, 2020 https://doi.org/10.1016/j.jocn.2019.08.085
  15. Frontera JA, Egorova N, Moskowitz AJ : National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Crit Care Med 39 : 1619-1625, 2011 https://doi.org/10.1097/CCM.0b013e3182186ed6
  16. Gordon N : Spontaneous intracranial hypotension. Dev Med Child Neurol 51 : 932-935, 2009 https://doi.org/10.1111/j.1469-8749.2009.03514.x
  17. Hashizume K, Watanabe K, Kawaguchi M, Fujiwara A, Furuya H : Evaluation on a clinical course of subdural hematoma in patients undergoing epidural blood patch for spontaneous cerebrospinal fluid leak. Clin Neurol Neurosurg 115 : 1403-1406, 2013 https://doi.org/10.1016/j.clineuro.2013.01.022
  18. Kim BR, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS : Utility of heavily T2- weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches. J Clin Neurosci 77 : 110-115, 2020 https://doi.org/10.1016/j.jocn.2020.05.010
  19. Kim J, Moon J, Kim T, Ahn S, Hwang G, Bang J, et al. : Risk factor analysis for the recurrence of chronic subdural hematoma: a review of 368 consecutive surgical cases. Korean J Neurotrauma 11 : 63-69, 2015 https://doi.org/10.13004/kjnt.2015.11.2.63
  20. Klein KM, Shiratori K, Knake S, Hamer HM, Fritsch B, Todorova-Rudolph A, et al. : Status epilepticus and seizures induced by iopamidol myelography. Seizure 13 : 196-199, 2004 https://doi.org/10.1016/S1059-1311(03)00077-3
  21. Louhab N, Adali N, Laghmari M, Hymer WE, Ben Ali SA, Kissani N : Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture. Int J Gen Med 7 : 71-73, 2014 https://doi.org/10.2147/IJGM.S48656
  22. Mao YT, Dong Q, Fu JH : Delayed subdural hematoma and cerebral venous thrombosis in a patient with spontaneous intracranial hypotension. Neurol Sci 32 : 981-983, 2011 https://doi.org/10.1007/s10072-011-0715-0
  23. Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Diaz-Alba A, Navarro VG : Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - a non-reported complication. Surg Neurol Int 11 : 316, 2020 https://doi.org/10.25259/SNI_385_2020
  24. Sayer FT, Bodelsson M, Larsson EM, Romner B : Spontaneous intracranial hypotension resulting in coma: case report. Neurosurgery 59 : E204; discussion E204, 2006 https://doi.org/10.1227/01.NEU.0000219843.34356.EE
  25. Schievink WI : Stroke and death due to spontaneous intracranial hypotension. Neurocrit Care 18 : 248-251, 2013 https://doi.org/10.1007/s12028-012-9800-3
  26. Schievink WI, Maya MM, Moser F, Tourje J, Torbati S : Frequency of spontaneous intracranial hypotension in the emergency department. J Headache Pain 8 : 325-328, 2007 https://doi.org/10.1007/s10194-007-0421-8
  27. Schievink WI, Maya MM, Moser FG, Tourje J : Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg 103 : 608-613, 2005 https://doi.org/10.3171/jns.2005.103.4.0608
  28. Schievink WI, Maya MM, Pikul BK, Louy C : Spontaneous spinal cerebrospinal fluid leaks as the cause of subdural hematomas in elderly patients on anticoagulation. J Neurosurg 112 : 295-299, 2010 https://doi.org/10.3171/2008.10.JNS08428
  29. Souirti Z, Benzagmout M, Belahsen F, Chaoui ME : Spontaneous bilateral subacute subdural hematoma revealing intracranial hypotension. Neurosciences (Riyadh) 14 : 384-385, 2009
  30. Takahashi K, Mima T, Akiba Y : Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases. Neurol Med Chir (Tokyo) 56 : 69-76, 2016 https://doi.org/10.2176/nmc.oa.2015-0032
  31. Tsai PH, Fuh JL, Lirng JF, Wang SJ : Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a casecontrol study. Cephalalgia 27 : 929-934, 2007 https://doi.org/10.1111/j.1468-2982.2007.01376.x
  32. Tsai PH, Fuh JL, Lirng JF, Wang SJ : Comparisons between heavily T2-weighted MR and CT myelography studies in two patients with spontaneous intracranial hypotension. Cephalalgia 28 : 653-657, 2008 https://doi.org/10.1111/j.1468-2982.2008.01562.x
  33. Wang YF, Lirng JF, Fuh JL, Hseu SS, Wang SJ : Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension. Neurology 73 : 1892-1898, 2009 https://doi.org/10.1212/WNL.0b013e3181c3fd99
  34. Whiteley W, Al-Shahi R, Myles L, Lueck CJ : Spontaneous intracranial hypotension causing confusion and coma: a headache for the neurologist and the neurosurgeon. Br J Neurosurg 17 : 456-458, 2003 https://doi.org/10.1080/02688690310001611251
  35. Yadav YR, Parihar V, Namdev H, Bajaj J : Chronic subdural hematoma. Asian J Neurosurg 11 : 330-342, 2016. https://doi.org/10.4103/1793-5482.145102
  36. Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG : Clinical experiences with spontaneous intracranial hypotension: a proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg 113 : 373-379, 2011 https://doi.org/10.1016/j.clineuro.2010.12.015