Lateral decubitus digital subtraction myelography to identify spinal CSF-venous fistulas in spontaneous intracranial hypotension
- 30 November 2019
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Spine
- Vol. 31 (6), 902-905
- https://doi.org/10.3171/2019.6.SPINE19487
Abstract
OBJECTIVE Spontaneous spinal CSF-venous fistulas are a distinct type of spinal CSF leak recently described in patients with spontaneous intracranial hypotension (SIH). Using digital subtraction myelography (DSM) with the patient in the prone position, the authors have been able to demonstrate such fistulas in about one-fifth of patients with SIH in whom conventional spinal imaging (MRI or CT myelography) showed no evidence for a CSF leak (i.e., the presence of extradural CSF). The authors compared findings of DSM with patients in the lateral decubitus position versus the prone position and now report a significantly increased yield of identifying spinal CSF-venous fistulas with this modification of their imaging protocol. METHODS The population consisted of 23 patients with SIH who underwent DSM in the lateral decubitus position and 26 patients with SIH who underwent DSM in the prone position. None of the patients had evidence of a CSF leak on conventional spinal imaging. RESULTS A CSF-venous fistula was demonstrated in 17 (74%) of the 23 patients who underwent DSM in the lateral decubitus position compared to 4 (15%) of the 26 patients who underwent DSM in the prone position (p < 0.0001). The mean age of these 16 women and 5 men was 52.5 years (range 36-66 years). CONCLUSIONS Among SIH patients in whom conventional spinal imaging showed no evidence of a CSF leak, DSM in the lateral decubitus position demonstrated a CSF-venous fistula in about three-fourths of patients compared to only 15% of patients when the DSM was performed in the prone position, an approximately five-fold increase in the detection rate. Spinal CSF-venous fistulas are not rare among patients with SIH.Keywords
This publication has 15 references indexed in Scilit:
- Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For ManagementWorld Neurosurgery, 2017
- A classification system of spontaneous spinal CSF leaksNeurology, 2016
- 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
- Spontaneous Intracranial HypotensionCONTINUUM: Lifelong Learning in Neurology, 2015
- CSF–venous fistula in spontaneous intracranial hypotensionNeurology, 2014
- The Role of Digital Subtraction Myelography in the Diagnosis and Localization of Spontaneous Spinal CSF LeaksAmerican Journal of Roentgenology, 2012
- Localization of a Rapid CSF Leak with Digital Subtraction MyelographyAmerican Journal Of Neuroradiology, 2008
- Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial HypotensionJama-Journal Of The American Medical Association, 2006