Introduction to Digital Subtraction Myelography for CSF-Venous Fistula Detection
================================================================================

* Ian T. Mark
* Ajay A. Madhavan
* John Benson
* Jared Verdoorn
* Waleed Brinjikji

## ABSTRACT

The purpose of this video is to introduce digital subtraction myelography for CSF-venous fistula (CVF) detectection.1⇓-3 CVF is the most recently identified and likely the most prevalent type of spinal CSF leak that leads to spontaneous intracranial hypotension4,5 CVFs are occult on conventional MRI and CT, necessitating the use of myelography for the diagnosis. This video highlights one such technique, which is important because an increasing number of centers are starting to diagnose CVF.

Video 1. 
The purpose of this video is to introduce digital subtraction myelography for CSF-venous fistula (CVF) detectection.1⇓-3 CVF is the most recently identified and likely the most prevalent type of spinal CSF leak that leads to spontaneous intracranial hypotension4,5 CVFs are occult on conventional MRI and CT, necessitating the use of myelography for the diagnosis. This video highlights one such technique, which is important because an increasing number of centers are starting to diagnose CVF.

## Footnotes

*   [Disclosure forms](https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/January%202025/0991.pdf) provided by the authors are available with the full text and PDF of this article at [www.ajnr.org](http://www.ajnr.org).

Indicates open access to non-subscribers at [www.ajnr.org](http://www.ajnr.org)

## References

1.  1.Kim DK, Brinjikji W, Morris PP, et al. Lateral decubitus digital subtraction myelography: tips, tricks, and pitfalls. AJNR Am J Neuroradiol 2020;41:21–28 doi:10.3174/ajnr.A6368 pmid:31857327
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo3OiI0MS8xLzIxIjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzQ2LzEvMjE5LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2.Hoxworth JM, Trentman TL, Kotsenas AL, et al. The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol 2012;199:649–53 doi:10.2214/AJR.11.8238 pmid:22915407
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.2214/AJR.11.8238&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=22915407&link_type=MED&atom=%2Fajnr%2F46%2F1%2F219.atom) 
    
    [Web of Science](http://www.ajnr.org/lookup/external-ref?access_num=000308150000050&link_type=ISI) 

3.  3.Mark I, Madhavan A, Oien M, et al. Temporal characteristics of CSF-venous fistulas on digital subtraction myelography. AJNR Am J Neuroradiol 2023;44:492–95 doi:10.3174/ajnr.A7809 pmid:36894299
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0NC80LzQ5MiI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80Ni8xLzIxOS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  4.Schievink WI, Moser FG, Maya MM. CSF-venous fistula in spontaneous intracranial hypotension. Neurology 2014;83:472–73 doi:10.1212/WNL.0000000000000639 pmid:24951475
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjg6IjgzLzUvNDcyIjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzQ2LzEvMjE5LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

5.  5.Mamlouk MD, Callen AL, Madhavan AA, et al. Spinal CSF leaks: the neuroradiologist transforming care. AJNR Am J Neuroradiol 2024;45:1613–20 doi:10.3174/ajnr.A8484 pmid:39209484
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czoxMDoiNDUvMTEvMTYxMyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80Ni8xLzIxOS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

*   Received October 6, 2024.
*   Accepted after revision November 4, 2024.


*   © 2025 by American Journal of Neuroradiology