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Published on: February 29, 2020
Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension: Do They Exist?
Wouter I Schievink1, M Marcel Maya1, Franklin Moser1
1Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis.
Multiple spinal cerebrospinal fluid (CSF) leaks are uncommon in patients with spontaneous intracranial hypotension (SIH). The frequency varies by leak type, with ventral leaks rarely being multiple, while lateral and CSF-venous fistula leaks show higher, though still uncommon, multiplicity.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Spontaneous intracranial hypotension (SIH) is a condition characterized by low cerebrospinal fluid (CSF) pressure.
- Identifying the source and number of CSF leaks is crucial for effective treatment.
- Digital subtraction myelography (DSM) is a key diagnostic tool for spinal CSF leaks.
Purpose of the Study:
- To determine the frequency of multiple spinal CSF leaks in patients with SIH.
- To investigate the relationship between the type of spinal CSF leak and the occurrence of multiple leaks.
- To assess the diagnostic yield of DSM in identifying multiple CSF leaks in SIH.
Main Methods:
- Observational study of 745 patients with SIH meeting International Classification of Headache Disorders criteria.
- Patients underwent digital subtraction myelography (DSM) between March 2009 and February 2020.
- Classification of spinal CSF leaks based on DSM findings (type 1a, 1b, and type 3).
Main Results:
- None of 291 patients with type 1a (ventral) leaks had multiple leaks.
- Multiple leaks were found in 6.2% of 65 patients with type 1b (lateral) leaks.
- Multiple CSF-venous fistulas (type 3) occurred in 9.3% of 97 patients; 5 patients had mixed leak types.
Conclusions:
- Multiple spinal CSF leaks are rare in SIH patients with ventral leaks.
- The incidence of multiple leaks is approximately 6% for lateral leaks and 9% for CSF-venous fistulas.
- Patients with SIH can generally be reassured about the low likelihood of multiple CSF leaks.
