Cerebrospinal Fluid Leaks: Challenges in Localizing Spontaneous Spinal Leak Sites and Minimally Invasive Treatment

World Neurosurg. 2024 Jul:187:294-303. doi: 10.1016/j.wneu.2024.03.114.

Abstract

The confirmation of cerebrospinal fluid (CSF) leaks in the setting of spontaneous intracranial hypotension (SIH) by imaging involves a growing toolset of multimodal advanced spinal and skull base imaging techniques, for which exists a unique set of challenges for each CSF leak type. Furthermore, the repertoire of minimally invasive CSF leak treatment beyond nontargeted epidural blood patch administration has grown widely, with varied practices across institutions. This review describes current diagnostic imaging and treatment modalities as they apply to the challenges of CSF leak localization and management.

Keywords: CSF-Venous fistula; Epidural blood patch; Epidural fibrin patch; Myelogram; Myelography; Spinal cerebrospinal fluid leak; Spinal longitudinal extradural collection.

Publication types

  • Review

MeSH terms

  • Blood Patch, Epidural / methods
  • Cerebrospinal Fluid Leak* / diagnostic imaging
  • Cerebrospinal Fluid Leak* / surgery
  • Cerebrospinal Fluid Leak* / therapy
  • Humans
  • Intracranial Hypotension* / diagnostic imaging
  • Intracranial Hypotension* / etiology
  • Intracranial Hypotension* / therapy
  • Magnetic Resonance Imaging
  • Minimally Invasive Surgical Procedures* / methods