These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system. The most common signs for cranial CSF leaks include chronic headaches and watery discharge from the nose or ear, especially on one side.
We identified 3 types of spontaneous spinal CSF leak in this observational study: the dural tear, the meningeal diverticulum, and the CSF-venous fistula. Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions. A total of 163 patients (28.7%) had an indeterminate type and extradural CSF collections were noted in 84 (51.5%) of these patients. Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients ) and these were not associated with extradural CSF collections. Type 2a represented simple diverticula (90.8%) and type 2b complex meningeal diverticula/dural ectasia (9.2%). A cerebrospinal fluid leak is a condition that occurs when the CSF leaks through a hole on the covering of the brain, the dura, and flows out into the nose or. Type 2 CSF leaks consisted of meningeal diverticula (240 patients ) and were the source of an extradural CSF collection in 53 of these patients (22.1%). This test is considered the gold standard for diagnosing and locating CSF leaks. CSF leaks causing spontaneous intracranial hypotension (SIH) are typically due to a leak in the spinal canal. Type 1a represented ventral CSF leaks (96%) and type 1b posterolateral CSF leaks (4%). CSF leak may also be spontaneous, due to intracranial tumors, idiopathic intracranial hypertension (IIH), or congenital skull defects. Type 1 CSF leaks consisted of a dural tear (151 patients ) and these were almost exclusively associated with an extradural CSF collection. Three types of CSF leak could be identified. The mean age of the 568 patients (373 women) was 45.7 years. We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks. Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Intracranial hypotension, also known as craniospinal hypotension is defined as cerebrospinal fluid (CSF) pressure <6 cm H 2 O in patients with clinical presentation compatible with intracranial hypotension, namely, postural headache, nausea, vomiting, neck pain, visual and hearing disturbances, and vertigo 17.
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