Introduction
The etiology of chronic subdural hematoma (cSDH) in non-geriatric patients (≤60 years) often remains unclear.
Aim
The primary objective of this study was to identify spinal cerebrospinal fluid (CSF) leaks in non-geriatric patients with the hypothesis that spinal CSF leaks are causally related to cSDH.
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Methods
All consecutive patients ≤ 60 years who were operated upon for cSDH from Sept. 2009 to April 2011 were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: magnetic resonance (MR) imaging of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT scanning. Spinal pathologies were classified according to direct proof of CSF outflow from intra- to extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings.
Results
Twenty-seven patients (mean age±SD: 49.6±9.2 years) were operated upon for cSDH. The chief complaint was headache in 15 (56%) patients. Hematomas were unilateral in 20 and bilateral in seven. In seven of 27 patients (25.9%) spinal CSF leakage was proven, in nine (33.3%) patients spinal meningeal cysts in the cervico-thoracic region were found, and three (11.1%) had spinal cysts in the sacral region. The remaining eight (29.6%) patients showed no pathological findings.
Conclusions
Spinal imaging results are challenging the pathogenetic concept of cSDH in young patients. The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of non-geriatric cSDH.
No conflict of interest.
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