![]() 13 The Bern SIH scores were not statistically significant ( P =. The range of type 3 CSF leak BMIs was 0.6–4.1 and 0.1–5.6, less than the national average BMIs for males and females, respectively. The BMIs were also compared with age- and sex-matched national BMI averages, and the range of type 1 CSF leak BMIs was 3.6–7 and 5.3–7.5, less than national average BMIs for males and females, respectively. A detailed analysis of the treatment outcomes is beyond the scope of this article. Last, a brief discussion on the type of CSF leak treatment will be mentioned and whether there was improvement of clinical symptoms. Before t test calculations, the Shapiro-Wilk test ( ) was calculated for each data set to determine the normal Gaussian distribution, with a test statistic (W) between 0.938 and 1 regarded as a normal distribution for our data set. ![]() This same statistical analysis was also performed on the Bern SIH scores, though it was not a main analysis of our study. 05 were considered statistically significant. To identify any differences in age, BMI, and spinal leak level among the 3 types of CSF leaks, we performed homoscedastic t tests (Excel Microsoft), and P values <. The sex, age, and BMI at the time of CSF leak diagnosis were recorded. Independent reviews of the myelograms were performed by 2 neuroradiologists with 8 and 11 years of experience with myelograms. In the setting of ruptured meningeal diverticula and CVFs, the laterality was documented. In the setting of dural tears, the presence or absence of a calcified disc was specified. The spinal CSF leak level was obtained in each patient, and the levels were further subdivided into cervical spine, upper thoracic spine (T1–T6 levels), lower thoracic spine (T7–T12 levels), and lumbar spine. Inclusion criteria consisted of the following: 1) SIH diagnosis according to the International Classification of Headache Disorders, 3rd edition 11 2) pretreatment Bern SIH scores on contrast-enhanced brain MRIs 12 and 3) spinal CSF leak detection using dynamic prone CT myelography (CTM) for ventral dural tears and decubitus CTM for ruptured meningeal diverticula and CVFs. The study population consisted of all patients with spontaneous spinal CSF leaks from August 2018 to March 2022 from a single institution. Institutional review board (Kaiser Permanente Medical Center) approval was obtained, which waived the requirement for informed consent. 10 The purpose of this article was to stratify the various types of spontaneous CSF leaks on the basis of age, BMI, and spinal leak level and to determine if there are key differences in these characteristics this knowledge can help guide physicians in determining which type of CSF leak and location is most likely to aid in the diagnostic work-up. Last, a holistic evaluation of the spinal leak location of the various types of spinal leaks has been described in only small series. To our knowledge, only 2 prior reports exist in a small number of patients, including a publication by Rosebrock et al, 8 which reported ventral dural CSF leaks in patients with low BMI values, while Schievink et al 9 reported BMI as it relates to CVF in the setting of morbid and super obesity. It has been established that obesity is a risk factor for cranial CSF leaks 7 however, there is minimal discussion about how BMI relates to spinal CSF leaks. Body mass index (BMI) is another feature that has not been well-described in patients with spontaneous CSF leaks. 5, 6 In 2016, Schievink et al 1 reported the average patient age at presentation for the various types of CSF leaks however, our detection of CVFs has grown exponentially since that date. It is known that spinal CSF leaks are more common in adults than in children and in females versus males. 2 ⇓- 4ĭespite these advancements, there are many unanswered questions, including why spontaneous CSF leaks occur and in what demographics. ![]() 1 In the past several years, our awareness and detection of these spinal CSF leaks have increased secondary to novel techniques such as dynamic prone myelography for dural tears and decubitus myelography for ruptured meningeal diverticula and CSF-venous fistulas (CVFs). Spontaneous intracranial hypotension (SIH) is typically secondary to a spinal CSF leak, and there are 3 main types: dural tears (type 1), ruptured meningeal diverticula (type 2), and CSF-venous fistulas (type 3). ABBREVIATIONS: BMI body mass index CTM CT myelography CVF CSF-venous fistula SIH spontaneous intracranial hypotension W Shapiro-Wilk test statistic ![]()
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