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Case Reports
. 2022 May 20:13:205.
doi: 10.25259/SNI_1084_2021. eCollection 2022.

Chronic CSF leak from lumbar-peritoneal shunt tract: A case report

Ali Bakhsh  1 , Mohamed Elmolla  1 , Neil Buxton  1 , Andrew Brodbelt  1
Affiliations
Case Reports

Chronic CSF leak from lumbar-peritoneal shunt tract: A case report

Ali Bakhsh et al. Surg Neurol Int. .

Abstract

Background: We describe a case of long-standing intracranial hypotension caused by an iatrogenic arachnoid diverticulum. This case illustrates two learning points. First, excessive CSF absorption may occur through an acquired arachnoid-epidural venous plexus at a dural defect. Second, a long-standing CSF leak may benefit from definitive surgical repair in the first instance.

Case description: A 55-year-old female, with known idiopathic intracranial hypertension, presented with disabling chronic low-pressure symptoms after having a lumboperitoneal shunt removed 5 years previously. MRI scan revealed a Chiari I malformation (CMI) and a small dural interruption at the L3/4 space. CT myelography confirmed the abnormality. Intraoperatively, a dural defect and arachnoid bleb with an overlying attachment of adipose tissue and a vessel were found. Postoperatively, the patient has marked resolution of her headaches and dizziness and is mobilizing independently.

Conclusion: Excessive CSF absorption appears to have occurred through an acquired arachnoid-epidural venous plexus. A high index of suspicion for intracranial hypotension is required in patients with low pressure symptoms and a CMI.

Keywords: CSF; Chiari; Intracranial hypotension; Shunt; Spine.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a) Sagittal T2W MRI scan showing tonsillar descent with effacement of cisterna magna. (b) Sagittal T1W MRI reported as normal but reveals dural defect (white arrow) at L3/4. (c) Sagittal CT myelogram showing a posterior dural outpouching at L3/4 (hollow white arrow). (d) Axial CT myelogram view of same central dural defect at L3/4 (hollow black arrow).
Figure 2:
Figure 2:
(a) Intraoperative view (diagrammatically illustrated below) shows adipose tissue (black arrow) with a vessel (white arrow) attached to underlying dura. (b) After adipose tissue excision, arachnoid enclosed CSF seen (hollow black arrow). Ligated vessels indicated by hollow white arrow. (c) Diagram of intra-operative pre-repair image above (black arrow showing adipose tissue). (d) Diagram of intra-operative post-repair image above (arachnoid enclosed CSF indicated by hollow white arrow).
See this image and copyright information in PMC

References

    1. Abrishamkar S, Khalighinejad N, Moein P. Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage. Acta Med Iran. 2013;51:467–71. - PubMed
    1. Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2012;33:535–40. - PMC - PubMed
    1. Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B. Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg. 1998;88:237–42. - PubMed
    1. Brodbelt A, Stoodley M. CSF pathways: A review. Br J Neurosurg. 2007;21:510–20. - PubMed
    1. Chumas PD, Armstrong DC, Drake JM, Kulkarni AV, Hoffman HJ, Humphreys RP, et al. Tonsillar herniation: The rule rather than the exception after lumboperitoneal shunting in the pediatric population. J Neurosurg. 1993;78:568–73. - PubMed

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