Spontaneous intracranial hypotension: diagnostic and therapeutic implications in neurosurgical practice

Spontaneous intracranial hypotension syndrome (SIH) is a complex pathological entity due to reduction of cerebrospinal fluid (CSF) volume and results into a variegated symptomatology, ranging from orthostatic headache to more severe conditions, such as stupor and coma; several attempts have been done in the past to understand the exact pathophysiological mechanisms which underlie its phenomenology, as well as different therapeutic approaches to relieve symptoms and reverse the reduction of overall CSF volume, both focally (in the case of a clear localized CSF leak) or by reversing the pressure gradient between the venous system and the subdural and epidural compartments (in the case of idiopathic SIH). The Authors’ experience is here reported, along with some pathophysiological and neuroradiological implications and considerations.