The Importance of Small Lateral Dural CSF Collections in Spontaneous Intracranial Hypotension: A Radiologic-Anatomic...

Area of Science:

• Neurosurgery
• Radiology
• Spinal Imaging

Background:

• Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH), leading to debilitating orthostatic headaches.
• Diagnosis of SIH often requires specialized and invasive spinal imaging techniques.
• Small lateral dural CSF collections on digital subtraction myelography (DSM) have unclear significance in SIH patients.

Purpose of the Study:

• To compare radiographic findings with intraoperative results in patients with SIH and small lateral dural CSF collections.
• To determine the diagnostic value of small lateral dural CSF collections identified via DSM in the context of SIH.

Main Methods:

• Retrospective cohort study of 27 patients with suspected SIH undergoing DSM and surgical exploration.
• Inclusion criteria: no spinal longitudinal extradural collection or CSF-venous fistula on initial imaging, DSM under general anesthesia, and surgery for small lateral dural CSF collections.
• DSM identified 31 small lateral dural CSF collections (0.6-2.4 mm diameter) caudal to the nerve root sleeve origin.

Main Results:

• Surgical exploration confirmed a CSF leak in all 27 patients.
• CSF-venous fistulas were identified in 23 patients; a pedicular lateral CSF leak was found in 4 patients.
• Radiographic differentiation between fistula and pedicular leak types was not consistently achievable via DSM.

Conclusions:

• Small lateral dural CSF collections detected by DSM in SIH patients are indicative of underlying CSF leaks.
• Surgical confirmation of CSF leaks in all studied patients validates DSM findings.
• These findings broaden diagnostic and therapeutic strategies for spontaneous intracranial hypotension.