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<meta name="DC.Title" content="Postsurgical Intracranial Hypotension: Diagnostic and Prognostic Imaging Findings" />
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<meta name="DC.Date" content="2010-01-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: CSF loss with consecutive intracranial hypotension has been discussed as a possible pathogenetic mechanism in poor clinical outcome after uneventful neurosurgery and appears to be correlated to specific imaging findings. The purpose of this study was to describe the clinical and imaging findings of symptomatic intracranial hypotension likely induced by wound suction drainage.

MATERIALS AND METHODS: This is a review of previously published cases of patients in whom this condition developed after uneventful intracranial surgery. We performed an analysis of 3 more cases, of which 2 occurred after spinal surgery with accidental dural opening.

RESULTS: Sixteen patients who remained unconscious or did not become fully responsive after surgery showed symmetric bilateral thalamic/basal ganglia signal intensity changes on CT and MR imaging studies. Of these 16 patients, 4 died and 2 also had brain stem signal intensity changes. All patients had rapid and distinct intraoperative and postoperative CSF loss documented on CT and/or MR imaging studies by a transient increase of the sag ratio, defined as maximal anteroposterior midbrain diameter by maximal bipeduncular diameter.

CONCLUSIONS: The clinical course and typical MR imaging findings characterize the disease entity postsurgical intracranial hypotension. These findings also underline the potential danger of wound suction drainage in the case of possible CSF loss." />
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<meta name="DC.Contributor" content="A. Kovács" />
<meta name="DC.Contributor" content="H. Tschampa" />
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&lt;p&gt;CSF loss with consecutive intracranial hypotension has been discussed as a possible pathogenetic mechanism in poor clinical outcome after uneventful neurosurgery and appears to be correlated to specific imaging findings. The purpose of this study was to describe the clinical and imaging findings of symptomatic intracranial hypotension likely induced by wound suction drainage.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This is a review of previously published cases of patients in whom this condition developed after uneventful intracranial surgery. We performed an analysis of 3 more cases, of which 2 occurred after spinal surgery with accidental dural opening.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Sixteen patients who remained unconscious or did not become fully responsive after surgery showed symmetric bilateral thalamic/basal ganglia signal intensity changes on CT and MR imaging studies. Of these 16 patients, 4 died and 2 also had brain stem signal intensity changes. All patients had rapid and distinct intraoperative and postoperative CSF loss documented on CT and/or MR imaging studies by a transient increase of the sag ratio, defined as maximal anteroposterior midbrain diameter by maximal bipeduncular diameter.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: CSF loss with consecutive intracranial hypotension has been discussed as a possible pathogenetic mechanism in poor clinical outcome after uneventful neurosurgery and appears to be correlated to specific imaging findings. The purpose of this study was to describe the clinical and imaging findings of symptomatic intracranial hypotension likely induced by wound suction drainage.

MATERIALS AND METHODS: This is a review of previously published cases of patients in whom this condition developed after uneventful intracranial surgery. We performed an analysis of 3 more cases, of which 2 occurred after spinal surgery with accidental dural opening.

RESULTS: Sixteen patients who remained unconscious or did not become fully responsive after surgery showed symmetric bilateral thalamic/basal ganglia signal intensity changes on CT and MR imaging studies. Of these 16 patients, 4 died and 2 also had brain stem signal intensity changes. All patients had rapid and distinct intraoperative and postoperative CSF loss documented on CT and/or MR imaging studies by a transient increase of the sag ratio, defined as maximal anteroposterior midbrain diameter by maximal bipeduncular diameter.

CONCLUSIONS: The clinical course and typical MR imaging findings characterize the disease entity postsurgical intracranial hypotension. These findings also underline the potential danger of wound suction drainage in the case of possible CSF loss." />
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MATERIALS AND METHODS: This is a review of previously published cases of patients in whom this condition developed after uneventful intracranial surgery. We performed an analysis of 3 more cases, of which 2 occurred after spinal surgery with accidental dural opening.

RESULTS: Sixteen patients who remained unconscious or did not become fully responsive after surgery showed symmetric bilateral thalamic/basal ganglia signal intensity changes on CT and MR imaging studies. Of these 16 patients, 4 died and 2 also had brain stem signal intensity changes. All patients had rapid and distinct intraoperative and postoperative CSF loss documented on CT and/or MR imaging studies by a transient increase of the sag ratio, defined as maximal anteroposterior midbrain diameter by maximal bipeduncular diameter.

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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">100-105; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1749 </span></div>
  
  
  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">D.R. Hadizadeh</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">A. Kovács</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">H. Tschampa</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-4"><span class="name">R. Kristof</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-5"><span class="name">J. Schramm</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a> and </li><li class="last" id="contrib-6"><span class="name">H. Urbach</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Departments of Radiology (D.R.H., A.K., H.T., H.U.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Neurosurgery (R.K., J.S.) University of Bonn Medical Center, Bonn, Germany.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Horst Urbach, MD, <span class="addr-line">Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud St 25, D-53105 Bonn, Germany</span>; e-mail: <span class="em-link"><span class="em-addr">urbach{at}uni-bonn.de</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/1/100.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">D.R.</span> <span class="nlm-surname">Hadizadeh</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Kovács</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Tschampa</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Kristof</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Schramm</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Urbach</span></span></span></div>
  
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