Brain Spontaneous Intracranial Hypotension Score for Treatment Monitoring After Surgical Closure of the Underlying Spinal Dural Leak.

Abstract

Spontaneous intracranial hypotension (SIH) is adebilitating condition requiring effective treatment; however, objective data on treatment response are scarce. To assess the suitability of the brain MRI-based SIH score (bSIH) for monitoring treatment success in SIH patients with aproven spinal cerebrospinal fluid (CSF) leak after microsurgical closure of the underlying dural breach. This retrospective cohort study included consecutive SIH patients with aproven spinal CSF leak, investigated at dedicated referral centre January 2012 to March 2020. The bSIH score integrates 6imaging findings; 3major (2points) and 3minor (1point), and ranges from 0to 9, with 0indicating low and 9high probability of spinal CSF loss. The score was calculated using brain magnetic resonance imaging (MRI) before and after surgical treatment of the underlying CSF leak. Headache intensity was registered on anumeric rating scale (NRS) (range 0-10). In this study 52 SIH patients, 35(67%) female, mean age 45.3years, with aproven spinal CSF leak were included. The mean bSIH score decreased significantly from baseline to after surgical closure of the underlying dural breach (6.9 vs. 1.3, P < 0.001). Adecrease in the NRS score was reported (8.6 vs. 1.2, P < 0.001). The bSIH score is asimple tool which may serve to monitor treatment success in SIH patients after surgical closure of the underlying spinal dural leak. Its decrease after surgical closure of the underlying spinal dural breach indicates restoration of an equilibrium within the CSF compartment.