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Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series.

Publication ,  Journal Article
Wang, TY; Karikari, IO; Amrhein, TJ; Gray, L; Kranz, PG
Published in: Oper Neurosurg (Hagerstown)
March 1, 2020

BACKGROUND: Cerebrospinal fluid-venous fistula (CVF) is a recently described cause of spontaneous intracranial hypotension (SIH). Surgical ligation of CVF has been reported, but clinical outcomes are not well described. OBJECTIVE: To determine the clinical efficacy of surgical ligation for treatment of CVF. METHODS: Outcomes metrics were collected in this prospective, single-arm, cross-sectional investigation. Inclusion criteria were as follows: diagnosis of SIH, demonstration of CVF on myelography, and surgical treatment of CVF. Pre- and postoperative headache severity was assessed with the Headache Impact Test (HIT-6), a validated headache scale ranging from 36 (asymptomatic) to 78 (most severe). Patient satisfaction with treatment was measured with Patient Global Impression of Change (PGIC). RESULTS: Twenty subjects were enrolled, with mean postoperative follow-up at 16.0 ± 9.7 mo. All CVFs were located in the thoracic region (between T4 and T12). Pretreatment headache severity was high (mean HIT-6 scores 65 ± 6). Surgical treatment resulted in marked improvement in headache severity (mean HIT-6 change of -21 ± -9, mean postoperative HIT-6 of 44 ± 8). Of subjects with baseline headache scores in the most severe category, 83% showed a major improvement in severity (transition to the lowest 2 severity categories) after surgery. All subjects (100%) reported clinically significant levels of satisfaction with treatment (PGIC score 6 or 7); 90% reported the highest level of satisfaction. There were no short- or long-term complications or 30-d readmissions. CONCLUSION: Surgical ligation is highly effective for the treatment of SIH due to CVF. Larger controlled trials with longer follow-up period are indicated to better assess its long-term efficacy and safety profile.

Duke Scholars

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Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

March 1, 2020

Volume

18

Issue

3

Start / End Page

239 / 245

Location

United States

Related Subject Headings

  • Prospective Studies
  • Myelography
  • Intracranial Hypotension
  • Humans
  • Fistula
  • Cross-Sectional Studies
 

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Wang, T. Y., Karikari, I. O., Amrhein, T. J., Gray, L., & Kranz, P. G. (2020). Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series. Oper Neurosurg (Hagerstown), 18(3), 239–245. https://doi.org/10.1093/ons/opz134
Wang, Timothy Y., Isaac O. Karikari, Timothy J. Amrhein, Linda Gray, and Peter G. Kranz. “Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series.Oper Neurosurg (Hagerstown) 18, no. 3 (March 1, 2020): 239–45. https://doi.org/10.1093/ons/opz134.
Wang, Timothy Y., et al. “Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series.Oper Neurosurg (Hagerstown), vol. 18, no. 3, Mar. 2020, pp. 239–45. Pubmed, doi:10.1093/ons/opz134.
Journal cover image

Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

March 1, 2020

Volume

18

Issue

3

Start / End Page

239 / 245

Location

United States

Related Subject Headings

  • Prospective Studies
  • Myelography
  • Intracranial Hypotension
  • Humans
  • Fistula
  • Cross-Sectional Studies