AJNR. American journal of neuroradiology · 2026
Does Change of Spinal Diverticular Size Predict the Site of De Novo Recurrent CSF-Venous Fistulas in Patients with Spontaneous Intracranial Hypotension?
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Schievink Wouter I, Maya Marcel M, Taché Rachelle B, Prasad Ravi S, Wadhwa Vikram, Moser Franklin G
Аннотация
BACKGROUND AND PURPOSE: Spinal CSF-venous fistulas are an important cause of spontaneous intracranial hypotension (SIH). Most of these fistulas are associated with a meningeal diverticulum, but they arise from the largest diverticulum in only approximately one-third of cases. De novo recurrent CSF-venous fistulas are defined as a CSF-venous fistula at a different spinal level (or side) after treatment of the initial CSF-venous fistula. Such de novo recurrent fistulas offer a unique opportunity to study the growth of diverticula before the development of a fistula.
MATERIALS AND METHODS: In this single-center retrospective observational study, data elements indicating a de novo recurrent fistula were extracted from a prospectively maintained database. Using this registry, we identified a consecutive group of patients with de novo recurrent fistulas.
RESULTS: The study population consisted of 9 women and 6 men (mean age: 57.9 years) with SIH and a de novo recurrent fistula. All patients had multiple diverticula, ranging from 3 to 35 diverticula per patient (total: 215 diverticula). The initial fistula was treated with microsurgical clip ligation in all patients. The mean interval between initial fistula treatment and de novo recurrent fistula formation was 2 years and 4 months (range, 5 months to 6 years and 6 months). A change in diverticular size (mean, 2 mm; range: 1-3 mm) associated with the de novo recurrent fistula was observed in 5 (33.3%) of the 15 patients. Diverticular size had increased in 3 patients and decreased in 2 patients. No change in size was observed in the other 195 meningeal diverticula.
CONCLUSIONS: We found that in one-third of patients, a change in diverticular size was observed corresponding to the site of the de novo recurrent fistula. An increase in diverticular size could be explained by increased diverticular wall tension (law of LaPlace), and attenuation of the diverticular wall resulting in a higher likelihood of developing a CSF-venous fistula and a decrease in size could be explained by decompression of the diverticulum through the fistula. A change in size of meningeal diverticula may help guide the invasive myelographic studies necessary to locate CSF-venous fistulas.
MATERIALS AND METHODS: In this single-center retrospective observational study, data elements indicating a de novo recurrent fistula were extracted from a prospectively maintained database. Using this registry, we identified a consecutive group of patients with de novo recurrent fistulas.
RESULTS: The study population consisted of 9 women and 6 men (mean age: 57.9 years) with SIH and a de novo recurrent fistula. All patients had multiple diverticula, ranging from 3 to 35 diverticula per patient (total: 215 diverticula). The initial fistula was treated with microsurgical clip ligation in all patients. The mean interval between initial fistula treatment and de novo recurrent fistula formation was 2 years and 4 months (range, 5 months to 6 years and 6 months). A change in diverticular size (mean, 2 mm; range: 1-3 mm) associated with the de novo recurrent fistula was observed in 5 (33.3%) of the 15 patients. Diverticular size had increased in 3 patients and decreased in 2 patients. No change in size was observed in the other 195 meningeal diverticula.
CONCLUSIONS: We found that in one-third of patients, a change in diverticular size was observed corresponding to the site of the de novo recurrent fistula. An increase in diverticular size could be explained by increased diverticular wall tension (law of LaPlace), and attenuation of the diverticular wall resulting in a higher likelihood of developing a CSF-venous fistula and a decrease in size could be explained by decompression of the diverticulum through the fistula. A change in size of meningeal diverticula may help guide the invasive myelographic studies necessary to locate CSF-venous fistulas.