Skip to main content
Advertisement
  • Main menu
  • User menu
  • Search
  • English ▼
    • English
    • Afrikaans
    • Albanian
    • Amharic
    • Arabic
    • Armenian
    • Azerbaijani
    • Basque
    • Belarusian
    • Bengali
    • Bosnian
    • Bulgarian
    • Catalan
    • Cebuano
    • Chichewa
    • Chinese (Simplified)
    • Chinese (Traditional)
    • Corsican
    • Croatian
    • Czech
    • Danish
    • Dutch
    • Esperanto
    • Estonian
    • Filipino
    • Finnish
    • French
    • Frisian
    • Galician
    • Georgian
    • German
    • Greek
    • Gujarati
    • Haitian Creole
    • Hausa
    • Hawaiian
    • Hebrew
    • Hindi
    • Hmong
    • Hungarian
    • Icelandic
    • Igbo
    • Indonesian
    • Irish
    • Italian
    • Japanese
    • Javanese
    • Kannada
    • Kazakh
    • Khmer
    • Korean
    • Kurdish (Kurmanji)
    • Kyrgyz
    • Lao
    • Latin
    • Latvian
    • Lithuanian
    • Luxembourgish
    • Macedonian
    • Malagasy
    • Malay
    • Malayalam
    • Maltese
    • Maori
    • Marathi
    • Mongolian
    • Myanmar (Burmese)
    • Nepali
    • Norwegian
    • Pashto
    • Persian
    • Polish
    • Portuguese
    • Punjabi
    • Romanian
    • Russian
    • Samoan
    • Scottish Gaelic
    • Serbian
    • Sesotho
    • Shona
    • Sindhi
    • Sinhala
    • Slovak
    • Slovenian
    • Somali
    • Spanish
    • Sudanese
    • Swahili
    • Swedish
    • Tajik
    • Tamil
    • Telugu
    • Thai
    • Turkish
    • Ukrainian
    • Urdu
    • Uzbek
    • Vietnamese
    • Welsh
    • Xhosa
    • Yiddish
    • Yoruba
    • Zulu

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

English ▼
  • English
  • Afrikaans
  • Albanian
  • Amharic
  • Arabic
  • Armenian
  • Azerbaijani
  • Basque
  • Belarusian
  • Bengali
  • Bosnian
  • Bulgarian
  • Catalan
  • Cebuano
  • Chichewa
  • Chinese (Simplified)
  • Chinese (Traditional)
  • Corsican
  • Croatian
  • Czech
  • Danish
  • Dutch
  • Esperanto
  • Estonian
  • Filipino
  • Finnish
  • French
  • Frisian
  • Galician
  • Georgian
  • German
  • Greek
  • Gujarati
  • Haitian Creole
  • Hausa
  • Hawaiian
  • Hebrew
  • Hindi
  • Hmong
  • Hungarian
  • Icelandic
  • Igbo
  • Indonesian
  • Irish
  • Italian
  • Japanese
  • Javanese
  • Kannada
  • Kazakh
  • Khmer
  • Korean
  • Kurdish (Kurmanji)
  • Kyrgyz
  • Lao
  • Latin
  • Latvian
  • Lithuanian
  • Luxembourgish
  • Macedonian
  • Malagasy
  • Malay
  • Malayalam
  • Maltese
  • Maori
  • Marathi
  • Mongolian
  • Myanmar (Burmese)
  • Nepali
  • Norwegian
  • Pashto
  • Persian
  • Polish
  • Portuguese
  • Punjabi
  • Romanian
  • Russian
  • Samoan
  • Scottish Gaelic
  • Serbian
  • Sesotho
  • Shona
  • Sindhi
  • Sinhala
  • Slovak
  • Slovenian
  • Somali
  • Spanish
  • Sudanese
  • Swahili
  • Swedish
  • Tajik
  • Tamil
  • Telugu
  • Thai
  • Turkish
  • Ukrainian
  • Urdu
  • Uzbek
  • Vietnamese
  • Welsh
  • Xhosa
  • Yiddish
  • Yoruba
  • Zulu
  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleHEAD AND NECK IMAGING
Open Access

Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension

Ian T. Mark, Jeremy Cutsforth-Gregory, Patrick Luetmer, Ajay A. Madhavan, Michael Oien, Paul Farnsworth, Girish Bathla, Steve Messina, Michael Link and Jamie Van Gompel
American Journal of Neuroradiology August 2024, DOI: https://doi.org/10.3174/ajnr.A8333
Ian T. Mark
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Ian T. Mark
Jeremy Cutsforth-Gregory
bDepartment of Neurology (J.C.-G.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Jeremy Cutsforth-Gregory
Patrick Luetmer
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Patrick Luetmer
Ajay A. Madhavan
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Ajay A. Madhavan
Michael Oien
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Michael Oien
Paul Farnsworth
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Paul Farnsworth
Girish Bathla
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Girish Bathla
Steve Messina
aFrom the Department of Radiology (I.T.M., P.L., A.A.M., M.O., P.F., G.B., S.M.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Steve Messina
Michael Link
cDepartment of Neurosurgery (M.L., J.V.G.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Michael Link
Jamie Van Gompel
cDepartment of Neurosurgery (M.L., J.V.G.), Mayo Clinic, Rochester, MN, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Jamie Van Gompel
  • Article
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • FIG 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 1.

    A 57-year-old man with a surgically proved right tegmen tympani CSF leak without brain MR imaging findings associated with SIH (Bern score = 0). A, Sagittal T1-weighted image shows normal suprasellar (dotted line), mamillopontine (broken line), and prepontine distances (solid line). B, Contrast-enhanced coronal T1-weighted image shows normal dura without thickening or enhancement. C, Sagittal image from an MRV shows a nondistended dominant transverse sinus (arrow).

  • FIG 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 2.

    Illustration of a patient with a spontaneous supratentorial skull base CSF leak in the middle cranial fossa (A) with preserved CSF flow at the foramen magnum (B). This is in contrast to a patient with a spinal CSF leak (C) that could include a ventral dural tear or CSF-venous fistula, and potential sump effect with craniocaudal CSF flow at the foramen magnum (D) that contributes to findings associated with SIH including brain sag and pituitary engorgement shown here.

Tables

  • Figures
    • View popup
    Table 1:

    Bern score criteria and scoring system

    Brain MRI FindingsPoints
    Diffuse dural enhancement/thickening2
    Suprasellar cistern ≤ 4 mm2
    Engorged venous sinus2
    Subdural fluid collection1
    Prepontine distance ≤ 5 mm1
    Mamillopontine distance ≤ 6.5 mm1
    • View popup
    Table 2:

    Interpretation of total Bern Score

    Probability of Spinal CSF LeakTotal Points
    Low≤2
    Intermediate3–4
    High≥5
    • View popup
    Table 3:

    Brain MRI findings in patients with skull base CSF leaks

    MRI Findings# Patients (%) n = 31
    Dural enhancement1 (3%)
    Small suprasellar distance (≤4 mm)2 (7%)
    Engorged venous sinus1 (3%)
    Subdural fluid collection0
    Small prepontine distance (≤5 mm)10 (32%)
    Small mamillopontine distance (≤6.5 mm)9 (29%)
    Mean Bern score (SD)0.9 (1.1)
    Lowlying cerebellar tonsils2 (7%)
PreviousNext
Back to top
Advertisement
Print
Download PDF
Email Article
Cite this article
0 Responses
Respond to this article
Share
Bookmark this article
Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension
Ian T. Mark, Jeremy Cutsforth-Gregory, Patrick Luetmer, Ajay A. Madhavan, Michael Oien, Paul Farnsworth, Girish Bathla, Steve Messina, Michael Link, Jamie Van Gompel
American Journal of Neuroradiology Aug 2024, DOI: 10.3174/ajnr.A8333
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Additional Diagnostic Value of Conebeam CT Myelography Performed after Digital Subtraction Myelography for Detecting CSF-Venous Fistulas
  • Spontaneous Intracranial Hypotension Associated with Vascular Malformations
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Hydrops Herniation into the Semicircular Canals
  • ASL Sensitivity for Head and Neck Paraganglioma
  • Post SRS Peritumoral Hyperintense Signal of VSs
Show more Head and Neck Imaging

Similar Articles

  • Intracranial Hypotension and Vascular Malformations
  • Spinal CSF Leaks: The Neuroradiologist Transforming Care
  • Revisiting a Rare Anomaly Described 25 Years Ago in the AJNR: A Journey from Pediatric Hemifacial Microsomia and Middle Cranial Fossa Aplasia to CSF-Lymphatic Fistula and Spontaneous Intracranial Hypotension as an Adult
  • Irregular Cervicothoracic Nerve Sheaths on Digital Subtraction Myelography: A CSF-Venous Fistula Mimic
See more
Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire
Email this Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
Ian T. Mark, Jeremy Cutsforth-Gregory, Patrick Luetmer, Ajay A. Madhavan, Michael Oien, Paul Farnsworth, Girish Bathla, Steve Messina, Michael Link, Jamie Van Gompel
Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension
American Journal of Neuroradiology Aug 2024, DOI: 10.3174/ajnr.A8333

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

We use cookies on this site to enhance your user experience. By clicking any link on this page you are giving your consent for us to set cookies.