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J Neurosurg Spine. 2019 Jul 5:1-4. doi: 10.3171/2019.4.SPINE19283. [Epub ahead of print]

False localizing signs of spinal CSF-venous fistulas in spontaneous intracranial hypotension: report of 2 cases.

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Departments of1Neurosurgery and.
2Radiology, Cedars-Sinai Medical Center, Los Angeles, California.


A spinal CSF-venous fistula is one of three specific types of spinal CSF leak that can be seen in patients with spontaneous intracranial hypotension (SIH). They are best demonstrated on specialized imaging, such as digital subtraction myelography (DSM) or dynamic myelography, but often they are diagnosed on the basis of increased contrast density in the draining veins (the so-called hyperdense paraspinal vein sign) on early postmyelography CT scans. The authors report on 2 patients who underwent directed treatment (surgery in one patient and glue injection in the other) based on the hyperdense paraspinal vein sign, in whom the actual site of the fistula did not correspond to the level or laterality of the hyperdense paraspinal vein sign. The authors suggest consideration of DSM or dynamic myelography prior to undertaking treatment directed at these fistulas.


DSM = digital subtraction myelography; SIH = spontaneous intracranial hypotension; cerebrospinal fluid–venous fistula; headache; intracranial hypotension; intracranial pressure; spinal CSF leak; surgical technique


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