{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:17:48Z","timestamp":1784107068111,"version":"3.55.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T00:00:00Z","timestamp":1609372800000},"content-version":"vor","delay-in-days":91,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Spontaneous intracranial hypotension describes the clinical syndrome brought on by a cerebrospinal fluid (CSF) leak. Orthostatic headache is the key symptom, but others include nausea, vomiting, and dizziness, as well as cognitive and mood disturbance. In severe cases, the brain slumps inside the cranium and subdural collections develop to replace lost CSF volume. Initial treatment is by bed rest, but when conservative measures fail, attention is focused on finding and plugging the leak, although this can be very difficult and some patients remain bedbound for months or years. Recently, we have proposed an alternative approach in which obstruction to cranial venous outflow would be regarded as the driving force behind a chronic elevation of CSF pressure, which eventually causes dural rupture. Instead of focusing on the site of rupture, therefore, investigation and treatment can be directed at locating and relieving the obstructing venous lesion, allowing intracranial pressure to fall, and the dural defect to heal. The case we describe illustrates this idea. Moreover, since there was a graded clinical response to successive interventions relieving venous obstruction, and eventual complete resolution, it also provides an opportunity to consider particular symptoms in relation to cerebral venous insufficiency in its own right.<\/jats:p>","DOI":"10.1055\/s-0040-1722268","type":"journal-article","created":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:43:33Z","timestamp":1609461813000},"page":"e59-e65","source":"Crossref","is-referenced-by-count":9,"title":["Spontaneous Intracranial Hypotension Complicated by Subdural Effusions Treated by Surgical Relief of Cranial Venous Outflow Obstruction"],"prefix":"10.1055","volume":"81","author":[{"given":"J Nicholas","family":"Higgins","sequence":"additional","affiliation":[{"name":"Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Axon","sequence":"additional","affiliation":[{"name":"Cambridge Skull Base Unit, Addenbrooke's Hospital, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Macfarlane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1111\/head.12149","article-title":"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks","volume":"53","author":"B Mokri","year":"2013","journal-title":"Headache"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1212\/WNL.0000000000002986","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"W I 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Kumar","year":"2016","journal-title":"Neurology"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.4065\/77.11.1241","article-title":"Intracranial hypertension after treatment of spontaneous cerebrospinal fluid leaks","volume":"77","author":"B Mokri","year":"2002","journal-title":"Mayo Clin Proc"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1177\/000348940611500703","article-title":"Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension","volume":"115","author":"R J Schlosser","year":"2006","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/WNO.0b013e318299c292","article-title":"Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension","volume":"33","author":"M A P\u00e9rez","year":"2013","journal-title":"J Neuroophthalmol"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.otohns.2008.02.010","article-title":"Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension","volume":"138","author":"B A Woodworth","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3109\/02688690309177979","article-title":"Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment","volume":"17","author":"B K Owler","year":"2003","journal-title":"Br J Neurosurg"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1212\/WNL.58.1.26","article-title":"Manometry combined with cervical puncture in idiopathic intracranial hypertension","volume":"58","author":"J O 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Base"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/00000658-195113430-00009","article-title":"Thrombosis of the dural venous sinuses as a cause of pseudotumor cerebri","volume":"134","author":"B S Ray","year":"1951","journal-title":"Ann Surg"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1212\/WNL.45.12.2224","article-title":"Cerebral venography and manometry in idiopathic intracranial hypertension","volume":"45","author":"J O King","year":"1995","journal-title":"Neurology"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1212\/WNL.46.1.198","article-title":"Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies","volume":"46","author":"D G Karahalios","year":"1996","journal-title":"Neurology"},{"key":"ref17","first-page":"1448000223","article-title":"What do lumbar puncture and jugular venoplasty say about a connection between chronic fatigue syndrome and idiopathic intracranial hypertension?","volume":"2014","author":"N Higgins","year":"2014","journal-title":"EJMINT Original Article"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"E795","DOI":"10.1227\/NEU.0b013e3182333859","article-title":"Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report","volume":"70","author":"S R Dashti","year":"2012","journal-title":"Neurosurgery"},{"issue":"02","key":"ref19","first-page":"158","article-title":"An evaluation of styloidectomy as an adjunct or alternative to jugular stenting in idiopathic intracranial hypertension and disturbances of cranial venous outflow","volume":"78","author":"J N Higgins","year":"2017","journal-title":"J Neurol Surg B Skull Base"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/cns.12859","article-title":"Understanding jugular venous outflow 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