CSF pressures in spontaneous intracranial hypotension due to CSF-venous fistula: A retrospective analysis.
Academic Article
Overview
abstract
OBJECTIVE: To report CSF pressure (Pcsf) and its correlations in patients with SIH due to CSF-venous fistula (CVF). METHODS: Following IRB approval, consecutive SIH patients undergoing myelography between 2021 and 2025 at a single center were retrospectively analyzed. Pcsf was defined as opening pressure (OP) during myelography, with patient in decubitus positioning with mild hip elevation. Low OP was defined as < 6 cm H2O; elevated OP as > 20 cm H2O. RESULTS: Of the 86 SIH patients analyzed, 35 (41 %) had a CVF [average age 59 ± 13; 12/35 (34 %) male; 23/35 (66 %) female]. Of the 35, OP was reported for 32 patients. The mean ± SD OP was 13.97 ± 3.91 cm H2O (range: 6-25 cm H2O). None (0 %) of the patients had low OP. 29/32 (91 %) had OP in normal range, 3/32 (9 %) had elevated OP. Pcsf was positively correlated with BMI (p = 0.045); but not correlated with age, sex, prior epidural blood patching, symptom duration, or mean arterial pressure. High variability in Pcsf values was not fully accounted for by predictors included in our model (pseudo-R2 = 0.188). CONCLUSIONS: An absence of low Pcsf should not be used to rule out SIH, as all our patients with SIH due to CVF had normal or elevated Pcsf. Such Pcsf readings in patients with active CSF leaks suggest that the development of CVF and post-treatment rebound headaches may be due to pre-existing intracranial hypertension. While BMI is positively correlated with Pcsf, limited explanatory power of our model suggests influence of other factors.
