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This study focuses on sacral dural tears as a\u00a0cause of SIH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective data from SIH patients with confirmed sacral dural tears studied between October 2020 and November 2022 were analyzed with respect to demographic, clinical and imaging features. Digital subtraction myelography (DSM) and lumbar epidural blood patch (EBP) were modified by placing the patient in reversed Trendelenburg position.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the SIH patients, 9 (all women; mean age, 38.5\u00a0years; mean body mass index, BMI, 22.9) out of 149 had a\u00a0sacral dural leak (6%) that occurred spontaneously in 7\/9, while 2\/9\u00a0were likely associated with minor trauma. None had a\u00a0sacral fracture. The mean SIH score was 6.8. All patients showed SLEC on heavily T2-weighted MR myelography (T2-MRM), 4\/9\u00a0exclusively sacral and 5\/9\u00a0with partial or complete involvement of the remaining spine. 4\/9\u00a0had none, but 5\/9\u00a0had meningeal sacral cysts, 2\/5\u00a0had large cysts\/ectasia. Confirmation of the sacral origin of the leak was provided in 4\/9\u00a0by T2-MRM, in 2\/9\u00a0by DSM and 3\/9\u00a0by CT myelography (CTM) whereas 0\/9\u00a0revealed the exact site of leak within the sacrum.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Sacral dural tears should be considered as a\u00a0possible cause for SIH. It is concluded to implement T2-MRM covering the entire sacrum in the standard MRI protocol and propose EBP in the reverse Trendelenburg position as a\u00a0therapeutic approach.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00062-023-01292-0","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T11:01:55Z","timestamp":1685617315000},"page":"957-964","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Sacral Dural Tears as a\u00a0Cause of Spontaneous Intracranial Hypotension"],"prefix":"10.1007","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-7863","authenticated-orcid":false,"given":"Niklas","family":"L\u00fctzen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique Barvulsky","family":"Aleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"El Rahal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Volz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"1292_CR1","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1097\/WCO.0000000000000105","volume":"27","author":"H Urbach","year":"2014","unstructured":"Urbach\u00a0H. 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