A novel technique for treatment of intractable spontaneous intracranial hypotension: lumbar dural reduction surgery

Headache. 2009 Jul;49(7):1047-51. doi: 10.1111/j.1526-4610.2009.01450.x. Epub 2009 May 15.


Background and objective: Spontaneous intracranial hypotension has become a well-described cause of headache particularly among young and middle-aged individuals. Treatment of the underlying spinal cerebrospinal fluid (CSF) leak is effective in relieving symptoms in the vast majority of patients but symptoms may become refractory. The author describes a novel surgical technique to treat intractable spontaneous intracranial hypotension.

Methods: A lumbar laminectomy is performed, a strip of dura is resected, and the dural defect is closed. The resulting decrease in lumbar CSF volume is believed to increase intracranial CSF volume and pressure.

Results: The technique was utilized in a patient who suffered with intractable positional headaches because of a spinal CSF leak for 6 years in spite of numerous surgical and nonsurgical therapies. Significant improvement of symptoms was sustained during a 1-year period of follow-up.

Conclusion: Dural reduction surgery may be considered in carefully selected patients with intracranial hypotension.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Dura Mater / surgery*
  • Female
  • Humans
  • Intracranial Hypotension / diagnostic imaging
  • Intracranial Hypotension / pathology
  • Intracranial Hypotension / surgery*
  • Laminectomy / methods*
  • Lumbosacral Region
  • Radiography
  • Tomography Scanners, X-Ray Computed