Surgical "Fat Patch" improves secondary intracranial hypotension orthostatic headache associated with lumbosacral dural ectasia. Case report.

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Surgical "Fat Patch" improves secondary intracranial hypotension orthostatic headache associated with lumbosacral dural ectasia. Case report.

World Neurosurg. 2017 Aug 30;:

Authors: Elena B, Andrea F, Roberto C, Vittoria N, Grazia VL, Angelo F

Abstract
BACKGROUND: Secondary intracranial hypotension is a clinical syndrome associated with the reduction of the cerebrospinal fluid volume and dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness and tinnitus. The treatment is usually non-specific.
CASE DESCRIPTION: The authors describe the case of a 37-years-old woman who developed secondary intracranial hypotension caused by lumbosacral iatrogenic dural ectasia following de-tethering surgery. An orthostatic headache was the mainstay of her clinical picture and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time (less than 1 month). Altered compliance of the dural spinal sac was suspected. Therefore thecal sac remodeling by placing autologous fat at the level of the dural ectasia was performed improving the symptoms for 2 years.
CONCLUSION: Volumetric reduction of the epidural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, and when an altered compliance of the dural sac is hypothesized.

PMID: 28866058 [PubMed - as supplied by publisher]

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