RT Journal Article SR Electronic T1 Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1593 OP 1596 DO 10.3174/ajnr.A8333 VO 45 IS 10 A1 Mark, Ian T. A1 Cutsforth-Gregory, Jeremy A1 Luetmer, Patrick A1 Madhavan, Ajay A. A1 Oien, Michael A1 Farnsworth, Paul A1 Bathla, Girish A1 Messina, Steve A1 Link, Michael A1 Van Gompel, Jamie YR 2024 UL http://www.ajnr.org/content/45/10/1593.abstract AB BACKGROUND AND PURPOSE: CSF leaks of the skull base and spine share a common process of CSF volume loss, and yet only the latter has been associated with spontaneous intracranial hypotension (SIH). Despite published claims that only spinal leaks cause SIH, no prior studies have evaluated brain MR imaging in patients with skull base leaks for findings associated with SIH, such as dural enhancement. The purpose of our study was to use a validated brain MR imaging scoring system to evaluate patients with skull base CSF leaks for findings associated with SIH.MATERIALS AND METHODS: We included patients with confirmed skull base CSF leaks and contrast-enhanced preoperative brain MRI. The preoperative MR images were reviewed for findings associated with SIH by using the Bern score. Patient age, presenting symptoms and their duration, and leak site were also recorded.RESULTS: Thirty-one patients with skull base CSF leaks were included. Mean Bern score was 0.9 (range 0–4, standard deviation 1.1), and only 1 patient (3%) had dural enhancement. Mean age was 53 years (range 18–76). Mean symptom duration was 1.3 years, with 22 patients presenting within 1 year of symptom onset. Twenty-three patients (74.2%) had intraoperative confirmation of leak from the middle cranial fossa, involving the temporal bone, while 7 (22.6%) had leaks from the anterior skull base. One patient, who had dural enhancement, had an infratentorial CSF leak along the petrous segment of the internal carotid artery.CONCLUSIONS: Our study provides further evidence that skull base and spinal CSF leaks represent distinct pathophysiologies and present with different brain MRI findings.IIHidiopathic intracranial hypertensionSIHspontaneous intracranial hypotension