The treatment

The treatment of CSF loss syndrome represents a so-called step-by-step scheme. In most cases, a conservative-wait-and-see treatment attempt is first carried out with bed rest for 3 days. It is not uncommon for a spontaneous closure of the CSF fistula to occur during this period.

If this is not the case, a so-called lumbar blood patch is performed in the next step. In this procedure, a mixture of the patient’s own blood and a radiopaque contrast medium is injected into the space around the spinal meninges (epidural space). This accumulation of fluid now presses on the causative open defect of the spinal cord skin and in many cases leads to a complete regression of the symptoms.

The correct position of the injected fluid is ensured by means of an X-ray image. The procedure is usually simple and can be performed on the ward. In cases in which this treatment option does not relieve symptoms, surgery is now available as the last treatment option.

This is usually carried out microsurgically and the tear is closed by suture or adhesions. In very severe cases of CSF loss syndrome and an initially severe symptomatology, the surgical intervention can be used as the first treatment option. In most cases, the patient can expect to be free of symptoms immediately after the operation.

Blood patches are always used when there was no spontaneous closure of the CSF fistula after sufficient bed rest. This procedure is often preferred to surgery because of its ease of use and extremely low complication rates. A mixture of the patient’s own blood taken from the vein and X-ray contrast medium is used as a blood patch.

The latter enables a subsequent position check of the blood patch. The demand rate for this type of treatment is approximately 85%. In case of a non-response, the procedure can be repeated several times. In addition, in addition to the lumbar blood patch, in which the entire epidural space (gap in the spinal cord) is filled, a more local application of this therapy is possible. However, this requires an exact localization of the defect.