CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography
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- 1 December 2017
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 209 (6), 1360-1366
- https://doi.org/10.2214/ajr.17.18351
Abstract
OBJECTIVE. The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). MATERIALS AND METHODS. We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM). Visibility of the CSF venous fistula on CTM and a modified conventional myelography technique we refer to as dynamic myelography was also compared. RESULTS. Twenty-two cases of CSF venous fistula were identified. The fistulas were located between T4 and L1. Ninety percent occurred without a concurrent epidural CSF leak. In most cases (82%), the CSF venous fistula originated from a nerve root sleeve diverticulum. On CTM, the abnormal veins associated with the CSF venous fistula were seen in a paravertebral location in 45% of cases, centrally within the epidural venous plexus in 32%, and lateral to the spine in 23%. Differences in attenuation between the fistula veins and the control veins was highly statistically significant (p < 0.0001), with a threshold of 70 HU perfectly discriminating fistulas from normal veins in our series. When both CTM and dynamic myelography were performed, the fistula was identified on both modalities in 88% of cases. CONCLUSION. CSF venous fistulas are an important cause of SIH that can be detected on both CTM and dynamic myelograph y and may occur without an epidural CSF leak. Familiarity with the imaging characteristics of these lesions is critical to providing appropriate treatment to patients with SIH.Keywords
This publication has 17 references indexed in Scilit:
- Spinal CSF venous fistula: A treatable etiology for CSF leaks in craniospinal hypovolemiaNeurology, 2016
- Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulasJournal of Neurosurgery: Spine, 2016
- The "Hyperdense Paraspinal Vein" Sign: A Marker of CSF-Venous FistulaAmerican Journal of Neuroradiology, 2016
- Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF PressureAmerican Journal of Neuroradiology, 2016
- Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial HypotensionAmerican Journal of Roentgenology, 2016
- Validation of the Headache Impact Test (HIT-6) in patients with chronic migraineHealth and Quality of Life Outcomes, 2014
- CSF–venous fistula in spontaneous intracranial hypotensionNeurology, 2014
- CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial HypotensionAmerican Journal of Neuroradiology, 2011
- Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraineCephalalgia, 2010
- The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the BrainAmerican Journal of Neuroradiology, 2007