![]() ![]() This evolution might represent an adaptive change, but its influence on outcome has never been investigated in a clinical setting. The orthostatic nature of the headache can become less obvious with increasing duration of the disease, a feature that is often accompanied by a change in CSF dynamics. It remains unclear, which patient benefits most from surgical treatment and which factors negatively affect outcome.Īs acknowledged by the International Headache Society in the 3rd edition of the International Classification of Headache Disorders (ICHD), and supported by our previous work, the clinical signs and symptoms associated with SIH can change over time. Despite definitive surgical closure of the leak, some patients suffer from residual symptoms. In refractory cases, surgical closure of the spinal CSF leak is a more definitive treatment. While epidural blood patching remains a commonly performed intervention for spinal CSF leaks, its response rate varies widely in the literature. SIH is mainly caused by a spinal cerebrospinal fluid (CSF) leak primarily located in the cervical and thoracic region. The hallmark symptom is orthostatic headache, but the clinical spectrum is diverse and encompasses other orthostatic symptoms such as visual or vestibulocochlear manifestations. It affects primarily young and middle-aged patients, with an estimated incidence of 5/100,000. Spontaneous intracranial hypotension (SIH) is an important cause of incapacitating headache. While an initial attempt of conservative treatment is justified, we advocate early definitive treatment within 12 weeks in case of persisting symptoms. Shorter duration of preoperative symptoms is the most powerful predictor of favorable outcome after surgical treatment of SIH. ROC analysis yielded treatment within 12 weeks as a cut-off for better outcome. Neither sex, age, type of pathology, lumbar opening pressure, nor initial presentation were associated with the primary outcome. Symptom duration remained a significant predictor in a multivariate model ( p = 0.013). ![]() A significant association with the primary and secondary outcome was found only for preoperative symptom duration ( p = 0.001 and p < 0.001), whereby a shorter symptom duration was associated with a better outcome. Mean age was 46.7 years and 68.1% were female. Sixty-nine out of 86 patients (80.2%) returned the questionnaire and were analyzed. A cut-off value for continuous variables was calculated by a ROC analysis. Association between variables and outcome was assessed using univariate and multivariate regression. ![]() Secondary outcome was postoperative headache intensity on the numeric rating scale (NRS). Primary outcome was resolution of symptoms as rated by the patient. Subjects were surveyed by a questionnaire. We included consecutive patients with SIH treated surgically from January 2013 to May 2020. Aim of the study was to assess predictors for favorable outcome after surgical treatment of SIH. Yet, some patients suffer from residual symptoms. Microsurgery can sufficiently seal spinal CSF leaks. Some valves have self-adjusting flow-regulating mechanisms, while others can only be adjusted using minimally invasive surgical procedures.Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH). These types of shunts DO NOT use an external magnetic field for valve adjustments. Non-Magnetic Externally Adjustable Valves Once implanted, no additional surgical procedures are required to change the setting of a magnetic externally adjustable shunt valve. This process, setting a valve to drain more or less fluid from the brain, is sometimes called “programming,” although the process involves no electronics. The magnetic field of the programming tool passes through the skin to adjust the position of the valve. To adjust these valves, a clinician places a magnetic tool on the skin near the valve and manually rotates it. ![]() Magnetic externally adjustable shunts have mechanical parts that can be moved non-invasively from outside the body. Magnetic Externally Adjustable Shunt Valves There are two types of adjustable CSF shunt valves: magnetic externally adjustable and non-magnetic externally adjustable. Adjustable shunt valves allow for changes to the amount of fluid that flows through the valve. Fixed shunt valves allow CSF fluid to drain when CSF pressure exceeds a certain “fixed” threshold. There are two types of CSF shunt valves: fixed and adjustable. Figure 1: Side-view of implanted CSF shunt system. ![]()
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