Lateral Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension: Radiologic-Anatomic Study of Different Variants

Imaging and intraoperative findings of spontaneous lateral spinal CSF leaks arising at the level of the pedicle. DSM (A) shows a small, defined lateral extradural CSF collection (arrow) at the level of the pedicle, not associated with the nerve root sleeve. Axial T2-weighted MRI (B) shows a corresponding small extradural CSF collection (arrow) that was not visible on post-DSM CT (C). The intrathecal contrast on the post-DSM CT is faint, possibly limiting the sensitivity of leak detection. Intraoperative photograph (D) shows a lateral dural tear (arrowheads) with arachnoid billowing out (asterisk) through the dural defect. DSMs (E–G) show a lateral dural tear (arrow) at the level of the pedicle, not associated with the nerve root sleeve, resulting in an extensive CSF leak, with CSF spreading in both cranial and caudal directions (arrowheads). Intraoperative photographs (H and I) show a linear dural tear (arrowheads) without arachnoid protruding through the dural tear. The underlying spinal cord is visible after spreading the dural tear (H).