A classification system of spontaneous spinal CSF leaks

Wouter I. Schievink, M. Marcel Maya, Stacey Jean-Pierre, Miriam A Nuno, Ravi S. Prasad, Franklin G. Moser

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks. Methods: We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension. Results: The mean age of the 568 patients (373 [65.7%] women) was 45.7 years. Three types of CSF leak could be identified. Type 1 CSF leaks consisted of a dural tear (151 patients [26.6%]) and these were almost exclusively associated with an extradural CSF collection. Type 1a represented ventral CSF leaks (96%) and type 1b posterolateral CSF leaks (4%). Type 2 CSF leaks consisted of meningeal diverticula (240 patients [42.3%]) and were the source of an extradural CSF collection in 53 of these patients (22.1%). Type 2a represented simple diverticula (90.8%) and type 2b complex meningeal diverticula/dural ectasia (9.2%). Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients [2.5%]) and these were not associated with extradural CSF collections. A total of 163 patients (28.7%) had an indeterminate type and extradural CSF collections were noted in 84 (51.5%) of these patients. Conclusions: We identified 3 types of spontaneous spinal CSF leak in this observational study: The dural tear, the meningeal diverticulum, and the CSF-venous fistula. These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system.

Original languageEnglish (US)
Pages (from-to)673-679
Number of pages7
JournalNeurology
Volume87
Issue number7
DOIs
StatePublished - Aug 16 2016
Externally publishedYes

Fingerprint

Diverticulum
Intracranial Hypotension
Tears
Fistula
Pathologic Dilatations
Macrophage Colony-Stimulating Factor
Granulocyte-Macrophage Colony-Stimulating Factor
Medical Records
Observational Studies

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Schievink, W. I., Maya, M. M., Jean-Pierre, S., Nuno, M. A., Prasad, R. S., & Moser, F. G. (2016). A classification system of spontaneous spinal CSF leaks. Neurology, 87(7), 673-679. https://doi.org/10.1212/WNL.0000000000002986

A classification system of spontaneous spinal CSF leaks. / Schievink, Wouter I.; Maya, M. Marcel; Jean-Pierre, Stacey; Nuno, Miriam A; Prasad, Ravi S.; Moser, Franklin G.

In: Neurology, Vol. 87, No. 7, 16.08.2016, p. 673-679.

Research output: Contribution to journalArticle

Schievink, WI, Maya, MM, Jean-Pierre, S, Nuno, MA, Prasad, RS & Moser, FG 2016, 'A classification system of spontaneous spinal CSF leaks', Neurology, vol. 87, no. 7, pp. 673-679. https://doi.org/10.1212/WNL.0000000000002986
Schievink WI, Maya MM, Jean-Pierre S, Nuno MA, Prasad RS, Moser FG. A classification system of spontaneous spinal CSF leaks. Neurology. 2016 Aug 16;87(7):673-679. https://doi.org/10.1212/WNL.0000000000002986
Schievink, Wouter I. ; Maya, M. Marcel ; Jean-Pierre, Stacey ; Nuno, Miriam A ; Prasad, Ravi S. ; Moser, Franklin G. / A classification system of spontaneous spinal CSF leaks. In: Neurology. 2016 ; Vol. 87, No. 7. pp. 673-679.
@article{5c4204c3340f49bebce64245b94ff866,
title = "A classification system of spontaneous spinal CSF leaks",
abstract = "Objective: Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks. Methods: We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension. Results: The mean age of the 568 patients (373 [65.7{\%}] women) was 45.7 years. Three types of CSF leak could be identified. Type 1 CSF leaks consisted of a dural tear (151 patients [26.6{\%}]) and these were almost exclusively associated with an extradural CSF collection. Type 1a represented ventral CSF leaks (96{\%}) and type 1b posterolateral CSF leaks (4{\%}). Type 2 CSF leaks consisted of meningeal diverticula (240 patients [42.3{\%}]) and were the source of an extradural CSF collection in 53 of these patients (22.1{\%}). Type 2a represented simple diverticula (90.8{\%}) and type 2b complex meningeal diverticula/dural ectasia (9.2{\%}). Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients [2.5{\%}]) and these were not associated with extradural CSF collections. A total of 163 patients (28.7{\%}) had an indeterminate type and extradural CSF collections were noted in 84 (51.5{\%}) of these patients. Conclusions: We identified 3 types of spontaneous spinal CSF leak in this observational study: The dural tear, the meningeal diverticulum, and the CSF-venous fistula. These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system.",
author = "Schievink, {Wouter I.} and Maya, {M. Marcel} and Stacey Jean-Pierre and Nuno, {Miriam A} and Prasad, {Ravi S.} and Moser, {Franklin G.}",
year = "2016",
month = "8",
day = "16",
doi = "10.1212/WNL.0000000000002986",
language = "English (US)",
volume = "87",
pages = "673--679",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - A classification system of spontaneous spinal CSF leaks

AU - Schievink, Wouter I.

AU - Maya, M. Marcel

AU - Jean-Pierre, Stacey

AU - Nuno, Miriam A

AU - Prasad, Ravi S.

AU - Moser, Franklin G.

PY - 2016/8/16

Y1 - 2016/8/16

N2 - Objective: Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks. Methods: We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension. Results: The mean age of the 568 patients (373 [65.7%] women) was 45.7 years. Three types of CSF leak could be identified. Type 1 CSF leaks consisted of a dural tear (151 patients [26.6%]) and these were almost exclusively associated with an extradural CSF collection. Type 1a represented ventral CSF leaks (96%) and type 1b posterolateral CSF leaks (4%). Type 2 CSF leaks consisted of meningeal diverticula (240 patients [42.3%]) and were the source of an extradural CSF collection in 53 of these patients (22.1%). Type 2a represented simple diverticula (90.8%) and type 2b complex meningeal diverticula/dural ectasia (9.2%). Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients [2.5%]) and these were not associated with extradural CSF collections. A total of 163 patients (28.7%) had an indeterminate type and extradural CSF collections were noted in 84 (51.5%) of these patients. Conclusions: We identified 3 types of spontaneous spinal CSF leak in this observational study: The dural tear, the meningeal diverticulum, and the CSF-venous fistula. These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system.

AB - Objective: Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks. Methods: We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension. Results: The mean age of the 568 patients (373 [65.7%] women) was 45.7 years. Three types of CSF leak could be identified. Type 1 CSF leaks consisted of a dural tear (151 patients [26.6%]) and these were almost exclusively associated with an extradural CSF collection. Type 1a represented ventral CSF leaks (96%) and type 1b posterolateral CSF leaks (4%). Type 2 CSF leaks consisted of meningeal diverticula (240 patients [42.3%]) and were the source of an extradural CSF collection in 53 of these patients (22.1%). Type 2a represented simple diverticula (90.8%) and type 2b complex meningeal diverticula/dural ectasia (9.2%). Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients [2.5%]) and these were not associated with extradural CSF collections. A total of 163 patients (28.7%) had an indeterminate type and extradural CSF collections were noted in 84 (51.5%) of these patients. Conclusions: We identified 3 types of spontaneous spinal CSF leak in this observational study: The dural tear, the meningeal diverticulum, and the CSF-venous fistula. These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system.

UR - http://www.scopus.com/inward/record.url?scp=84983042874&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983042874&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002986

DO - 10.1212/WNL.0000000000002986

M3 - Article

VL - 87

SP - 673

EP - 679

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 7

ER -