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  • CT-guided percutaneous cyanoacrylate injection targeting the spinal cerebrospinal fluid leak: a potential therapeutic option for spontaneous intracranial hypotension

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New devices and techniques
Case series
CT-guided percutaneous cyanoacrylate injection targeting the spinal cerebrospinal fluid leak: a potential therapeutic option for spontaneous intracranial hypotension
  1. Liang Liao1,2,
  2. Romain Tonnelet1,3,
  3. Emmanuelle Schmitt1,
  4. Sophie Planel1,
  5. François Zhu1,3,
  6. Patricio Muszynski1,4,
  7. Oana Harsan1,3,
  8. René Anxionnat1,3,
  9. Serge Bracard1,3,
  10. Marc Braun1,3
  1. 1 Department of Diagnostic and Interventional Neuroradiology, CHRU de Nancy, Nancy, Lorraine, France
  2. 2 LORIA, Vandoeuvre-les-Nancy, Grand Est, France
  3. 3 University of Lorraine, Nancy, Grand Est, France
  4. 4 Instituto Oulton, Cordoba, Argentina
  1. Correspondence to Dr Liang Liao, Department of Diagnostic and Interventional Neuroradiology, CHRU de Nancy, 54000 Nancy, Lorraine, France; l.liao{at}chru-nancy.fr

Abstract

Background We report the first case series of spontaneous intracranial hypotension (SIH) patients who underwent CT-guided percutaneous cyanoacrylate injection targeting the cerebrospinal fluid (CSF) leak.

Methods A retrospective analysis was performed for all consecutive cases of SIH patients with CSF leak confirmed on CT myelography, treated by CT-guided percutaneous cyanoacrylate injection at our institution from 2016 to 2022. On pretreatment brain and spine MRIs, we analyzed signs of SIH according to the Bern score, and dichotomized cases into positive/negative for spinal longitudinal extradural CSF collection (SLEC-P or SLEC-N). The leaks detected on CT myelography were classified into three types according to Schievink et al. We collected the Headache Impact Test 6 (HIT-6) scores throughout a 6-month follow-up, with a brain CT scan at each visit.

Results 11 patients were included (mean age 48.4 years, six men). Five SLEC-P type 1, three SLEC-P type 2, and three SLEC-N type 3 leaks were identified. All patients had significant signs of SIH on pretreatment brain MRI (mean Bern score 7.8±1.1). Six patients underwent a foraminal puncture, and five patients had a cervical epidural approach. Two patients experienced mild and transient locoregional pain after cervical epidural injection. Mean HIT-6 score at baseline was 66.8±3.2 and at the 6-month follow-up was 38±3.6 (P<0.001). All patients achieved improvement in their symptoms, with 82% of them (9/11) having complete resolution of headaches and SIH findings on CT scans at 6 months. No clinical worsening or recurrence was observed.

Conclusions CT-guided percutaneous cyanoacrylate injection may be a potential therapeutic option for the different types of CSF leak causing SIH.

  • Spine
  • Intervention
  • Intracranial Pressure
  • Liquid Embolic Material
  • Technique

https://doi.org/10.1136/jnis-2022-020004

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    Footnotes

    • Twitter @anoia_gill, @patricioemusz

    • Contributors LL made substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of data as well as drafted the work and gave final approval of the published version and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RT, ES, SP, FZ, PM, OH, RA, SB and MB made substantial contributions to the acquisition, analysis and interpretation of data and revised it critically for important intellectual content and gave final approval of the published version, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LL is responsible for the overall content and is the guarantor of the entire work. He accepts full responsibility for the work and conduct of the study, had access to the data and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.