Komplike İntrakraniyal Hipotansiyon Yönetimi

Cafer İkbal Gülsever; Alperen Poyraz; Duygu Dölen; Aydın Aydoseli

doi:10.37609/akya.3289

Yazarlar

Cafer İkbal Gülsever

https://orcid.org/0000-0002-9246-1378

Alperen Poyraz

https://orcid.org/0000-0002-3885-5894

Duygu Dölen

https://orcid.org/0000-0002-6929-4401

Aydın Aydoseli

https://orcid.org/0000-0002-4695-8295

DOI: https://doi.org/10.37609/akya.3289.c11947

Özet

Spontan intrakraniyal hipotansiyon (SİH), beyin omurilik sıvısı (BOS) kaçakları nedeniyle gelişen nadir bir durumdur. BOS-venöz fistüller (BVF), SİH'nin nadir ancak önemli bir nedeni olup, tanı için ileri görüntüleme gerektirir. Tedavi genellikle endovasküler embolizasyon gibi minimal invaziv yöntemleri içerir. Bununla birlikte çeşitli sebeplerle tedavi süreci karmaşık hale gelebilir. 52 yaşında bir kadın hasta, uzun süreli SİH semptomları ile başvurdu. Başlangıçta C6-C7 seviyesindeki kalsifiye disk hernisine bağlı bir BOS kaçağı tespit edildi. Daha sonra BVF gelişimi görüldü. Lomber kan yamalarına rağmen semptomlar devam etti. BVF, endovasküler embolizasyon ile kapatıldı. Ancak sekonder intrakraniyal hipertansiyon gelişti ve asetazolamid tedavisine yanıt alınamayınca ventriküloperitoneal şant (VPŞ) yerleştirildi. Hastanın semptomları VPŞ sonrasında tamamen düzeldi. Bu olgu, SİH'nin karmaşık yönetimini ve BVF'nin tanı ve tedavisindeki zorlukları vurgulamaktadır. Serebellar tonsiller herniasyon gibi komplikasyonların erken fark edilmesi ve tedavi edilmesi büyük önem taşır. Sekonder intrakraniyal hipertansiyonun yönetimi de tedavi sürecinin kritik bir parçasıdır.

Spontaneous intracranial hypotension (SIH) is a rare condition caused by cerebrospinal fluid (CSF) leaks. CSF-venous fistulas (CVF) represent an uncommon but significant cause of SIH, often requiring advanced imaging for diagnosis. Treatment frequently involves minimally invasive techniques such as endovascular embolization. However, rebound intracranial hypertension can complicate the treatment after CSF leak closure. A 52-year-old female presented with a prolonged history of SIH. Initially, an anterior epidural CSF collection due to a calcified C6-C7 disc herniation was detected. Later, a CVF was identified. Despite lumbar blood patches, the symptoms persisted. The CVF was successfully treated with endovascular embolization. However, rebound intracranial hypertension developed, and the patient did not respond to acetazolamide. As a result, a ventriculoperitoneal shunt (VPS) was placed, leading to significant symptom improvement. The patient has been symptom-free since the procedure. This case illustrates the complexities of managing SIH and the challenges associated with CVF diagnosis and treatment. Early recognition and management of secondary complications, such as cerebellar tonsillar herniation, are crucial. The management of rebound intracranial hypertension, especially when it requires a VPS, also represents a critical component in the treatment process.

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