Wir überwinden Grenzen

Severe headaches that disappear when lying down indicate negative pressure in the brain / Study on diagnosis and therapy in the journal Lancet Neurology / Medical Center - University of Freiburg is a world leader in minimally invasive treatment

In some people, a bony spine pierces the skin of the spinal cord like the tip of a sharp knife. This causes cerebrospinal fluid to leak into the surrounding tissue. The resulting negative pressure in the brain leads to severe headaches when standing, which quickly disappear when lying down. An international team led by Prof. Dr. Jürgen Beck, Medical Director of the Department of Neurosurgery at the Medical Center - University of Freiburg, presents important diagnostic and therapeutic options in a recently published review on so-called spontaneous cerebrospinal fluid loss syndrome, SIH for short. The study was published on February 25, 2022 in the renowned journal Lancet Neurology.

Brain on dry land

"Such positional headaches, also known as orthostatic pain, are extremely stressful and can severely restrict those affected in their everyday lives. It is therefore all the more gratifying that we can often cure those affected with an operation," says Beck. "At the Medical Center - University of Freiburg, we treat the most affected patients worldwide with minimally invasive surgery and operate on more patients than any other center in Europe."

In cerebrospinal fluid leakage syndrome, cerebrospinal fluid, which actually flows around the brain and spinal cord along the spinal column, flows out of the closed system. "This creates a negative pressure and the brain is literally left high and dry," explains the neurosurgeon. Noises in the ears, photophobia, nausea and perceptual disorders can also occur. In addition, there are non-specific symptoms such as an increased heart rate, concentration problems and dizziness, which subside when lying down.

In order to heal the symptoms, the millimeter-sized spinous process of the spine must first be found and removed. The leak in the skin of the spinal cord, which is often no larger than the head of a pin, is then closed. This can be done with a suture or by injecting a tiny amount of the patient's own blood into the area. The blood clots and closes the hole. "Today, we can only perform the operation in a minimally invasive way and in some cases even via the blood vessels using a catheter. This means that patients have few side effects and a quick healing process," explains Beck.

Sensitizing physicians to the clinical picture

Just a few years ago, only experts were aware of the clinical picture of spontaneous cerebrospinal fluid loss syndrome. This is why the first regular conference for the treatment of SIH patients in Germany was set up at the Medical Center - University of Freiburg. Here, unclear findings can be clarified quickly and competently. The study that has now been published was compiled in collaboration with scientists from Switzerland, the USA and Canada. "We want to raise physicians' awareness of the clinical picture and lay the foundations for a medical guideline. Both should help those affected to be cured more quickly," says Beck.

Original title of the publication: Spontaneous intracranial hypotension: searching for the CSF leak
DOI: 10.1016/S1474-4422(21)00423-3
Link to the study: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00423-3/

Caption: The bony spine can be recognized as a tiny light line. The illustration shows how it pierces the meninges and can leak cerebrospinal fluid.
Image source: Lancet Neurology 2022, "Spontaneous intracranial hypotension: searching for the CSF leak", Dobrocky et al. 2022, reprinted with permission from Elsevier

Further information:

Info page on cerebrospinal fluid leak syndrome: https: //www.uniklinik-freiburg.de/neurochirurgie/schwerpunkte/intrakranielle-hypotension.html

Contact:
Prof. Dr. Jürgen Beck
Medical Director
Department of Neurosurgery
Medical Center - University of Freiburg
Phone: 0761 270-50060
j.beck@uniklinik-freiburg.de