CSF pressures in spontaneous intracranial hypotension due to CSF-venous fistula: A retrospective analysis

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-22 DOI:10.1016/j.clineuro.2025.109169

Bala McRae-Posani , Sara Strauss , Matthew S. Robbins , Gayle Salama

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引用次数: 0

Abstract

Objective

To report CSF pressure (P_csf) 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. P_csf 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. P_csf 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 P_csf values was not fully accounted for by predictors included in our model (pseudo-R² = 0.188).

Conclusions

An absence of low P_csf should not be used to rule out SIH, as all our patients with SIH due to CVF had normal or elevated P_csf. Such P_csf 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 P_csf, limited explanatory power of our model suggests influence of other factors.

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脑脊液静脉瘘所致自发性颅内低血压患者脑脊液压力的回顾性分析

目的探讨脑脊液压力（Pcsf）与脑脊液静脉瘘（CVF）致SIH的相关性。方法：在IRB批准后，回顾性分析2021年至2025年间在单一中心接受脊髓造影的连续SIH患者。Pcsf定义为脊髓造影时的开口压力（OP），患者采用卧位，髋部轻度抬高。低OP定义为<； 6 cm H2O；OP升高为>； 20 cm H2O。结果86例SIH患者中，35例（41 %）有CVF[平均年龄59 ± 13；男性12/35(34 %)；23/35（66 %）女性]。在35例患者中，有32例报告OP。平均±SD OP为13.97 ± 3.91 cm H2O（范围：6 ~ 25 cm H2O）。无患者OP低（0 %），29/32（91 %）患者OP正常，3/32（9 %）患者OP升高，Pcsf与BMI呈正相关（p = 0.045）；但与年龄、性别、既往硬膜外补血、症状持续时间或平均动脉压无关。我们的模型中包含的预测因子不能完全解释Pcsf值的高变异性（伪r2 = 0.188）。结论没有低Pcsf不能作为排除SIH的依据，因为我们所有由CVF引起的SIH患者的Pcsf均正常或升高。活动性脑脊液泄漏患者的Pcsf读数提示CVF和治疗后反弹性头痛的发生可能是由于先前存在的颅内高压所致。虽然BMI与Pcsf呈正相关，但我们模型的解释能力有限，表明有其他因素的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.