Prognosis
Prognosis: The Prospect of Recovery with a Spinal CSF Leak
Prognosis, from the Greek word meaning “foreknowledge,” means “the likely outcome or course of a disease.” And the prognosis for many patients with spinal CSF leak is favorable—when the diagnosis is recognized and appropriate treatment is offered.
Prognosis for iatrogenic leaks (leaks resulting from medical procedures)
For those with iatrogenic leaks, the vast majority of patients do very well. Lumbar punctures causing head pain respond to lumbar epidural blood patching (EBP) procedures the majority of the time, but occasionally an EBP will need to be repeated, or an epidural patch with fibrin sealant will be required. On rare occasions, a surgical repair is necessary. Inadvertent punctures or tears of the dura from epidural injections are usually addressed successfully with one or more epidural blood patches, however there are reported cases in which a surgical repair was needed. Dural defects that occur during spinal surgery often require an open surgical repair.
Prognosis for spontaneous spinal CSF leaks
Spontaneous spinal CSF leaks appear to be associated with either spinal pathology and/or abnormal dura in the majority of cases. These patients do well overall, although some may require several procedures. Some patients with spontaneous leaks have symptoms that resolve spontaneously in a matter of hours, days, or weeks without ever seeking medical care.
A substantial percentage of patients respond favorably to one or more epidural blood patching procedures. When EBP is unsuccessful or if symptoms recur, spinal imaging findings help to guide further treatment. Epidural patching with fibrin sealant may be directed at the leak location, or a surgical repair may be the best option. Surgical repair of spinal CSF leaks have good success rates in the hands of experienced neurosurgeons.
Prognosis for rebound intracranial hypertension (RIH) following successful leak treatment
Rebound Intracranial Hypertension (elevated CSF pressure) may occur following treatment. This usually presents with a different pattern of headache in location, quality, and positional aspect, but is not always readily distinguished from the headache associated with intracranial hypotension (low volume of CSF in the brain). Associated symptoms may be similar or dissimilar from pre-treatment. Because research on this has been limited to date, the natural history and best treatment approaches have not yet been clarified. Acetazolamide is the medication prescribed most often, but several other medications are also in use.