![]() ![]() If symptoms persist, it is imperative to continue looking for the leak. Many clinics perform an evaluation without finding the leak.After lumbar puncture, the chance of spontaneous healing is almost 100%, but in the case of dura tear because of a mini-spur, it is significantly lower. However, if closure of the dural leak does not occur relatively quickly (spontaneously or by surgery), or if the cause is a dural slit due to a microspur, a chronic clinical picture may develop in which the symptoms change, spread, and lead to complaints that are atypical and often wrongly classified as "psychogenic." Severe symptoms can be expected, ranging from severe impairment to practical bedriddenness. CSF leaks are often benign and have a high spontaneous healing rate.The specific methods of diagnosis and the staging scheme are often not known. Over the last few years, we have therefore been able to gain important insights into the decoding of this rare disease: Inselspital is one of the three largest centers in Europe in the special field of cerebrospinal fluid leaks. If relief from symptoms is not achieved even after 2 blood patch treatments, surgical closure of the CSF leak should be performed because otherwise the headache may progress to a chronic stage with increasing involvement of cranial nerves and more severe vegetative symptoms. This minimally invasive procedure is very often successful. In the short term, therefore, a blood patch nearly always improves symptoms, even if it is placed far from the leak. The effect of the blood patch comes not from gluing the hole shut, but from compressing the dural sac, which prevents as much cerebrospinal fluid from flowing from the head into the spinal dural sac when the patient stands up or sits down. The blood patch is usually applied to the lower back at the level of the 3rd/4th lumbar vertebra. In this procedure, the patient's own blood, which was taken from a vein shortly beforehand, is injected into the space around the spinal cord membranes (epidural space). ![]() If no spontaneous closure of the CSF fistula occurs through bed rest, the next step is a so-called blood patch.
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