Spontaneous Spinal Cerebrospinal Fluid Leak: Review and Management Algorithm

Abstract

Spontaneous spinal cerebrospinal fluid (CSF) leak is a condition that commonly presents with debilitating positional headaches. Often, the cause of the leak is located in the spine. Although often cured with conservative management, including epidural blood patching, a subset of patients are refractory to this initial management. Determining the focal location of the spinal leak can, in some patients, require several imaging modalities. Treatment similarly involves multiple options, including targeted epidural blood and/or fibrin patching as well as surgical closure. In this article, we review the current literature regarding this challenging condition and present an algorithm for management.

Keywords: Cerebrospinal fluid leak; Cerebrospinal fluid venous fistula; Orthostatic headache; Positional headache; Spontaneous intracranial hypotension.