RT Journal Article
SR Electronic
T1 Improved Cerebral Glymphatic Flow after Transvenous Embolization of CSF-Venous Fistula
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 961
OP 964
DO 10.3174/ajnr.A8229
VO 45
IS 7
A1 Schartz, Derrek
A1 Finkelstein, Alan
A1 Zhong, Jianhui
A1 Brinjikji, Waleed
A1 Bender, Matthew T.
YR 2024
UL http://www.ajnr.org/content/45/7/961.abstract
AB Spontaneous intracranial hypotension is characterized by symptoms of low intracranial CSF volume due to various mechanisms of CSF leakage. One such mechanism is a CSF-venous fistula, treatable with transvenous embolization resulting in substantial radiographic and clinical improvement. However, the exact mechanisms underlying these improvements, including the potential involvement of the glymphatic system, remain unclear. To noninvasively assess glymphatic clearance in spontaneous intracranial hypotension, we used an advanced MR imaging technique called the DTI along the perivascular spaces in 3 patients with CSF-venous fistula before and after embolization. All 3 patients with spontaneous intracranial hypotension initially had low glymphatic flow, which improved postembolization. Two patients with symptomatic improvement exhibited a more substantial increase in glymphatic flow compared with a patient with minimal improvement. These findings suggest a possible link between cerebral glymphatics in spontaneous intracranial hypotension pathophysiology and symptomatic improvement, warranting larger studies to explore the role of the glymphatic system in spontaneous intracranial hypotension.CSFVFCSF-venous fistulaDTI-ALPSDTI analysis along the perivascular spaceFAfractional anisotropySIHspontaneous intracranial hypotension