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Updated: Aug 23, 2026

A Murine Model of Subarachnoid Hemorrhage
Published on: November 21, 2013
Brain Volume Changes After Targeted Closure of Spinal CSF Leak in Spontaneous Intracranial Hypotension
Juliette-Agathe Mirtil1, Jeremy Deverdun1, Liesjet Eh van Dokkum1
1From the Institute of Human Functional Imaging (I2FH), Montpellier University Hospital, Gui de Chauliac, Montpellier, France; Sorbonne Université, Faculty of Science & Engineering, Paris, France; Neuroradiology department, Montpellier University Hospital, Gui de Chauliac, Montpellier, France; Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland; and Neurology department, Montpellier University Hospital, Gui de Chauliac, Montpellier, France.
Background And Purpose:
To characterize brain morphometric adaptations following targeted CSF leak closure using automated volumetry.
Materials And Methods:
In this retrospective, single-center, longitudinal study, 61 patients with confirmed spontaneous intracranial hypotension (SIH) who underwent targeted treatment (neurosurgical repair for dural tears; endovascular embolization for CSF-venous fistulas) were included. Brain MRI was performed at baseline, 24 hours post-treatment (n=41), and at 3-month follow-up. Bern scores and automated volumetric Z-scores of CSF, gray matter, white matter, ventricular compartments, and brainstem subregions were derived using the DL-MorphoBox research application and compared longitudinally with Wilcoxon signed-rank tests and Bonferroni correction for multiple comparisons.
Results:
Marked radio-clinical improvement was observed at 3 months post-treatment, with increased total CSF volume (ΔZ=+0.66; p<0.001) across all ventricular compartments (p<0.001). In parallel, brain parenchymal volume decreased (ΔZ=-0.60; p<0.001), presumably driven by gray matter contraction (ΔZ = -0.57; p<0.001), involving the temporal (ΔZ =-0.46; p < 0.001), frontal (ΔZ=-0.64; p=0.01), and prefrontal (ΔZ=-0.37; p=0.007) cortices. Finaly, brainstem volume decreased as well (ΔZ=-0.27; p=0.04). The MRI-based volumetric changes were detectable as early as 24 hours post-treatment, with lateral ventricular volume expansion continuing to 3 months. While the Bern score correlated with ventricular volume variations (p<0.001), it was unrelated to gray matter contraction.
Conclusions:
Targeted CSF leak closure induced a rapid, subtle reorganization of intracranial compartments, primarily characterized by ventricular expansion alongside gray matter and brainstem volume contraction. Gray matter volumetric modifications were detectable even in people with low-intermediate Bern scores. This establishes quantitative volumetry as an objective monitoring tool for treatment evaluation across the full spectrum of SIH severity.
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