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