Abstract Details

Title Cerebrospinal Fluid Leak in the context of Pars Interarticularis Fracture: A Case Series

Topic Headache

Presentation(s) P15 - Poster Session 15 (12:00 PM-1:00 PM)

Poster/Presentation
Number 7-008

Objective NA

Background Cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important cause of sudden onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential cause of a CSF leak. A targeted epidural patch with fibrin sealant to the fracture site can improve response rate and thus clinical outcome.

Design/Methods A cohort of patients was evaluated at the Stanford CSF leak headache clinic between 2016 and 2019. All cases were presented at the combined neuroradiology-headache neurology CSF leak conference. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium contrast as well as MRI and computed tomography (CT) myelogram of the entire spine. All targeted epidural patches with fibrin sealant were performed by a team member board-certified in Headache, Anesthesiology, and Pain Medicine. Treatment response was measured based on a pain intensity scale from 1 to 10, 10 being the most severe.

Results Nine patients were diagnosed with a CSF leak and PI fracture. Three of the patients were excluded given pending targeted epidural patches. The average age at the time of onset of headache was 39 years (males: 39 years; females: 39 years). The average time to targeted epidural patches with fibrin sealant was 4.5 years. All six patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant. All patients had significant improvement in their headache intensity and associated symptoms.

Conclusions Our cases highlight: 1) the potential importance of PI fracture as the site of CSF leak in patients with intracranial hypotension; 2) the superiority of CT over MRI for detecting these fractures in patients with intracranial hypotension; and 3) the successful treatment of previously refractory spinal CSF leak when targeting the fracture site.

Authors/Disclosures
Lik Hang Tommy Chan, MD (Western University) PRESENTER	No disclosure on file
Robert Cowan, MD, F�鶹��ýӳ�� (Stanford Neurosciences Health Center)	Dr. Cowan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Cowan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. Dr. Cowan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbvie. Dr. Cowan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. Dr. Cowan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Cowan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for lundbeck. Dr. Cowan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for biohavenn. Dr. Cowan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbviie. Dr. Cowan has stock in Percept. Dr. Cowan has received intellectual property interests from a discovery or technology relating to health care. Dr. Cowan has received intellectual property interests from a discovery or technology relating to health care. Dr. Cowan has received publishing royalties from a publication relating to health care.
Nada A. Hindiyeh, MD (Stanford University Medical Center)	Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alder/Lundbeck. Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Impel. Dr. Hindiyeh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck .
	No disclosure on file
	No disclosure on file
Ian Carroll	No disclosure on file

�鶹��ýӳ��

�鶹��ýӳ��