Spinal Cerebrospinal Fluid Leak as the Cause of Chronic Subdural Hematomas in Young Patients
Aim: The etiology of chronic subdural hematoma (cSDH) in non-geriatric patients (≤60 years) often remains unclear. The primary objective of this study was to identify spinal cerebrospinal fluid (CSF) leaks in young patients with the hypothesis that spinal CSF leaks are causally related to cSDH.
Methods: All consecutive patients 60 years of age or younger who were operated upon for cSDH from Sept. 2009 to April 2011 were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: magnetic resonance (MR) imaging of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT scanning. Spinal pathologies were classified according to direct proof of CSF outflow from intra- to extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was the proof of a CSF leak.
Results: Twenty-seven patients (mean age ± SD: 49.6 ± 9.2 years) were operated upon for cSDH. Hematomas were unilateral in 20 and bilateral in seven. In seven of 27 patients (25.9%) spinal CSF leakage was proven, in nine (33.3%) patients spinal meningeal cysts in the cervico-thoracic region were found, and three (11.1%) had spinal cysts in the sacral region. The remaining eight (29.6%) patients showed no pathological findings.
Conclusions: The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of non-geriatric cSDH.