目的:脊髓脑脊液(CSF)漏的显微手术密封是自发性颅内低血压(SIH)的可行治疗选择。几个因素可能会影响结果,症状持续时间可能是最可修改的变量。
方法:这项回顾性单中心研究纳入了2020年9月至2023年3月间脊髓脑脊液漏闭合和6个月随访期的患者。头痛影响的术前和术后评分(头痛影响测试,HIT-6)和生活质量(QoL,系统收集EQ-5D-5L)。对这些结果进行了不同症状持续时间和合并症的多元回归建模和亚组分析。
结果:100名患者(61%为女性,中位年龄43.5岁)。术后六个月,头痛影响有显著改善(HIT-6:66(IQR62-69)至52(IQR40-61,p<0.001)和QoL(EQ-5D-5LVAS:40(IQR30-60)至79(IQR60-90);EQ-5D-5L指数:0.67(IQR0.8-0.94)至0.91(IQR分别为0.35-0.94,p<0.001亚组分析的症状持续时间高于(74%)和低于90天(26%)和合并症,以及多元回归分析,显示出有利于早期治疗和降低共病的趋势。然而,即使在症状持续时间延长之后,改进是显著的。
结论:由于症状持续时间较短的患者表现出更好的预后趋势,我们的结果促进了SIH患者的及时诊断和治疗.然而,即使在症状持续时间延长后,仍可预期术后明显改善.
OBJECTIVE: Microsurgical sealing of spinal cerebrospinal fluid (CSF) leaks is a viable treatment option in spontaneous intracranial hypotension (SIH). Several factors may influence the outcome, with symptom duration probably the most modifiable variable.
METHODS: Patients with closure of spinal CSF leaks between September 2020 and March 2023 and a follow-up period of 6 months were included in this retrospective single-center study. Pre- and postoperative scores for impact of headaches (Headache Impact Test, HIT-6) and quality of life (QoL, EQ-5D-5L) were systematically collected. Multiple regression modelling and subgroup analyses for different symptom durations and comorbidities were performed for these outcomes.
RESULTS: One hundred patients (61% female, median age 43.5 years) were included. Six months postoperatively, there was significant improvement in headache impact (HIT-6: 66 (IQR 62-69) to 52 (IQR 40-61, p < 0.001) and QoL (EQ-5D-5L VAS: 40 (IQR 30-60) to 79 (IQR 60-90); EQ-5D-5L Index: 0.67 (IQR 0.35-0.8) to 0.91 (IQR 0.8-0.94, p < 0.001, respectively). Subgroup analysis for a symptom duration above (74%) and below 90 days (26%) and comorbidity, as well as multiple regression analysis, revealed a trend in favor of early treatment and lower comorbidity. However, even after a prolonged symptom duration, improvements were significant.
CONCLUSIONS: As patients with shorter symptom duration show a trend for a better outcome, our results promote a timely diagnosis and treatment in SIH patients. However, a significant postoperative improvement can still be expected even after a prolonged symptom duration.