• 대한핵의학회지
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• 제33권2호
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• pp.184-188
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• 1999

Although cerebrospinal fluid leakage is suggested as one of the causes of spontaneous intracranial hypotension, only a few cases with direct evidence of cerebrospinal fluid leakage on radionuclide cisternography have been reported in the literature. Indirect evidences of cerebrospinal fluid leakage such as early visualization of the soft tissue and bladder or delayed migration of radiotracer have been observed in most patients with spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension in which cerebrospinal fluid leakage was directly demonstrated by early dynamic imaging of spine on radionuclide cisternography. We suggest that early dynamic imaging of spine is an important adjunctive procedure in detecting cerebrospinal fluid leakage in patients with spontaneous intracranial hypotension.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.62-64
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• 2016

Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.59-61
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• 2013

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.348-353
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• 2022

Traumatic brain injury (TBI) is a major public health issue that causes significant morbidity and mortality in the pediatric population. Pediatric minor TBIs are the most common and are widely underreported because not all patients seek medical attention. The specific management of these patients is distinct from that of adult patients because of the different physiologies in these age groups. This article focuses on minor TBIs, particularly growing skull fractures, traumatic cerebrospinal fluid leakage, and concussion.

• The Korean Journal of Pain
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• 제23권1호
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• pp.46-50
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• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• 대한두개안면성형외과학회지
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• 제21권1호
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• pp.45-48
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• 2020

In neurosurgical cases, problems related to wound healing can vary from simple wound dehiscence to multilayer defects. This study demonstrates an effective method to prevent persistent cerebrospinal fluid (CSF) leakage using reinforcing acellular dermal matrix in neurosurgical patients with wound dehiscence. A 52-year-old woman was admitted for management of recurrent glioblastoma. After tumor removal surgery, the patient experienced sustained CSF leakage from the wound despite reparative attempts. The plastic surgery team performed wound repair procedure after remnant tumor removal by the neurosurgery team. Acellular dermal matrix was applied over the mesh plate to prevent CSF leakage and the postoperative status of the patient was evaluated. No sign of CSF leakage was found in the immediate postoperative period. After 3 years, there were no complications including CSF leakage, wound dehiscence, and infection. We hereby propose this method as a feasible therapeutic alternative for preventing CSF leakage in patients experiencing wound problem after neurosurgical procedures.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.640-643
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• 2000

Objective : In neurosurgical practice, it has been generally accepted that when the dura is opened, it should be watertightly closed, and traditionally non-watertight closure has not been performed. We clinically tried non-watertight closure, analyzed the frequency of CSF leakage and evaluated the possible clinical application of non-watertight closure. Methods : After classifying our cases with supratentorial and infratentorial approach, we tried non-watertight and watertight closures and compared the results. We also analyzed the cases with or without dural graft. Results : In supratentorial approach, the rate of cerebrospinal fluid leakage noted in non-watertight closure was similar to that of watertight closure. In infratentorial approach, except microvascular decompression(MVD), the rate of cerebrospinal fluid leakage in non-watertight closure was higher than that of watertight closure. Dura graft application did not seemed to influence the cerebrospinal fluid leakage. Conclusion : Since the frequency of cerebrospinal fluid leakage was not higher in non-watertight closure than that of watertight closure, non-watertight closure can be applied in supratentorial approach. In infratentorial approach, non-watertight closure may be applied in surgery with relatively short dural incision, such as MVD. However, non-watertight closure doesn't seem to be appropriate in surgery that requires wide dural incision, such as skull base surgery.

• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.240-243
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• 2012

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

• Investigative Magnetic Resonance Imaging
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• 제17권2호
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• pp.149-153
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• 2013

척추 수술의 합병증으로 뇌척수액 누출이 발생할 수 있는데 이를 영상학적으로 진단하는 것은 어려움이 있다. 이 연구에서는 자기공명척수조영술을 이용하여 척추 수술 후 뇌척수액 누출을 확인하였던 두 환자의 증례를 보고하고자 한다. 두 환자는 각기 요추 추간판 절제술과 척추 수막종 제거술을 받은 뒤 심한 두통을 호소하였다. 두 환자의 자기공명척수조영영상에서 척추 뇌수막액 누출 부위가 확인되었고, 이에 대해 환자들은 각각 epidural blood patch와 재수술을 받았다. 이 두 사례에서 자기공명척수조영술은 척추 뇌수막액의 누출 부위를 정확히 보여주었고, 척수강과 가성수막류 (pseudomeningocele) 사이의 교통로를 잘 나타내주었다. 척수 수술 후 뇌수막액 누출을 확인하기 위한 검사로 자기공명척수조영술이 유용한 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.112-117
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• 2013

Objective : We performed this study to investigate whether the use of closed-suction drainage following microvascular decompression (MVD) causes cerebrospinal fluid (CSF) leakage. Methods : Between 2004 and 2011, a total of 157 patients with neurovascular compression were treated with MVD. MVD was performed for hemifacial spasm in 150 (95.5%) cases and for trigeminal neuralgia in 7 (4.5%) cases. The mean age of the patients was $49.8{\pm}9.6$ years (range, 20-69). Dural substitutes were used in 44 (28.0%) patients. Ninety-two patients (58.6%) were underwent a 4-5 cm craniotomy using drainage (drainage group), and 65 (41.4%) did a small 2-2.5 cm retromastoid craniectomy without closed-suction drainage (no-drainage group). Results : Eleven (7.0%) patients experienced CSF leakage following MVD based on the criteria of this study; all of these patients were in the drainage group. In the unadjusted analyses, the incidence of CSF leakage was significantly related with the use of closed-suction drainage following MVD (12.0% in the drainage group vs. 0% in the no-drainage group, respectively; p=0.003; Fisher's exact test). Those who received dural substitutes and the elderly (cut-off value=60 years) exhibited a tendency to develop CSF leakage (p=0.075 and p=0.090, respectively; Fisher's exact test). In the multivariate analysis, only the use of closed-suction drainage was significantly and independently associated with the development of CSF leakage following MVD (odds ratio=9.900; 95% confidence interval, 1.418 to infinity; p=0.017). Conclusion : The use of closed-suction drainage following MVD appears to be related to the development of CSF leakage.