Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache

Abstract

A 58-year-old woman experienced incapacitating headache and occipital paresthesiae for 5 years after lumbar myelography. Conservative methods of treatment failed. Successive investigations for a suspected cerebrospinal fluid (CSF) leak were unrevealing. Leakage of CSF from the subarachnoid space into the epidural space in the lumbar region was finally confirmed when oil-soluble contrast material (Pantopaque), injected into the cervical subarachnoid space, was revealed by a specific technical modification to be escaping from the lumbar sac. Repair of the dural defect with dorsolumbar fascia resulted in almost complete alleviation of symptoms. This case is unusual because of the radiographic technique used, the duration of symptoms, and the rarity of reports of successful surgical treatment for this serious complication of lumbar puncture.