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Prevalence and Characteristics of Microspurs in Patients with Spontaneous Intracranial Hypotension Compared with the
Danial Nasiri1, Levin Häni2, Johannes Goldberg2
1From the Department of Neurosurgery (D.N., L.H., J.G., T.P., R.T.S., A.R., C.M.J.), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland danial.nasiri@insel.ch.
Background And Purpose:
In patients diagnosed with spontaneous intracranial hypotension (SIH), microspurs are considered the culprit lesion in most ventral dural leaks (type I). The imaging characteristics of discogenic spurs, and their prevalence in the general population has not been reported in the literature.
Materials And Methods:
This observational case-control study was conducted comparing the prevalence and characteristics of discogenic microspurs between patients with SIH with a type I leak treated at a tertiary hospital between 2013 and 2023 and an age- and sex-matched cohort of trauma patients.
Results:
Each group consisted of 85 patients (mean age 51.6 ± 11.9 years), 74% (58/85 patients) were women. The prevalence of discogenic microspurs in the control group and SIH group was 31.8% and 90.6%, respectively. The mean length of the culprit microspur responsible for a dural leak was larger compared with the mean length of all coincidental microspurs from both the SIH and the control group not causing a dural leak (2.6 mm versus 1.6 mm, P < .001). Our multivariate logistic regression revealed that an increasing length of a microspur (OR, 1.942, CI 1.35-2.80, P < .001) and a narrower diameter of the spinal canal (OR, 0.85, CI 0.76-0.96, P = .008) were predictive for a dural tear.
Conclusions:
A discogenic microspur is a common incidental finding and may be found in almost one-third of the general population. The length of the culprit microspur and the diameter of the spinal canal are distinct morphologic characteristics for type I associated CSF leaks.
Insights
Discogenic microspurs are common in spontaneous intracranial hypotension (SIH) patients, with longer spurs and narrower spinal canals predicting dural leaks. This finding aids in diagnosing cerebrospinal fluid (CSF) leaks.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Imaging
Background:
- Microspurs are implicated in ventral dural leaks causing spontaneous intracranial hypotension (SIH).
- The prevalence and imaging characteristics of discogenic spurs in the general population are not well-documented.
Purpose of the Study:
- To compare the prevalence and characteristics of discogenic microspurs in SIH patients with type I leaks versus a trauma patient control group.
- To identify imaging features predictive of dural tears.
Main Methods:
- An observational case-control study compared 85 SIH patients with type I leaks to 85 age- and sex-matched trauma patients.
- Prevalence and microspur characteristics were analyzed, including length and spinal canal diameter.
Main Results:
- Discogenic microspurs were found in 90.6% of SIH patients versus 31.8% of controls.
- Culprit microspurs causing leaks were significantly longer (2.6 mm vs. 1.6 mm).
- Microspur length and narrower spinal canal diameter predicted dural tears.
Conclusions:
- Discogenic microspurs are common incidental findings, present in nearly one-third of the general population.
- Microspur length and spinal canal diameter are key morphologic predictors for type I cerebrospinal fluid leaks.
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