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. 2024 Aug 9;45(8):E28-E29.
doi: 10.3174/ajnr.A8308.

Expounding on the Distinction between Lateral Dural Tears and Leaking Meningeal Diverticula in Spontaneous Intracranial Hypotension

Ajay A Madhavan  1 , Richard I Farb  2 , Waleed Brinjikji  1 , Jeremy K Cutsforth-Gregory  3 , Wouter I Schievink  4
Affiliations

Expounding on the Distinction between Lateral Dural Tears and Leaking Meningeal Diverticula in Spontaneous Intracranial Hypotension

Ajay A Madhavan et al. AJNR Am J Neuroradiol. .
No abstract available

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Figures

FIG 1.
FIG 1.
Lateral CSF leaks in 3 patients (A, Leaking meningeal diverticulum. B and C, Lateral dural tears with herniated arachnoid diverticula). In the first patient, 30-minute delayed left lateral decubitus CT myelography (CTM) shows paraspinal contrast accumulation at L2 (A, solid arrow) adjacent to a small meningeal diverticulum (A, dashed arrow), compatible with a leaking diverticulum. In the second patient, a coronal image from decubitus photon-counting CTM (B) shows a left T12 lateral dural tear with an arachnoid diverticulum herniating through the dural defect (B, solid arrow) and separate extradural contrast accumulation (B, dashed arrows). In the third patient, axial image from a decubitus photon-counting CTM (C) shows a right T11 lateral dural tear, again with an arachnoid diverticulum herniating through the dural tear (C, solid arrow) and separately leaking extradural contrast (C, dashed arrow). In this case, the precise site of the dural defect was clearly seen (C, arrowhead).
FIG 2.
FIG 2.
Intraoperative photograph demonstrating the typical appearance of a lateral dural tear inferior to the nerve root sleeve (asterisk). A dural tear (solid arrow) is seen with a thin arachnoid diverticulum (dashed arrows) herniating or “billowing” out from the defect. The actual site of CSF leak was from the edges of the dural tear itself (solid arrow) rather than the diverticulum.
See this image and copyright information in PMC

References

    1. Schievink WI, Maya MM, Jean-Pierre S, et al. A classification system of spontaneous spinal CSF leaks. Neurology 2016;87:673–79 10.1212/WNL.0000000000002986 - DOI - PubMed
    1. Farb RI, Nicholsobn PJ, Massicotte EM, et al. Spontaneous intracranial hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography. AJNR Am J Neuroradiol 2019;40:745–53 10.3174/ajnr.A6016 - DOI - PMC - PubMed
    1. Schievink WI, Maya MM, Tay AS-MS, et al. Lateral spinal CSF leaks in patients with spontaneous intracranial hypotension: radiologic-anatomic study of different variants. AJNR Am J Neuroradiol 2024;45:951–56 10.3174/ajnr.A8261 - DOI - PMC - PubMed
    1. Madhavan AA, Verdoorn JT, Shlapak DP, et al. Lateral decubitus dynamic CT myelography for fast cerebrospinal fluid leak localization. Neuroradiology 2022;64:1897–903 10.1007/s00234-022-02985-y - DOI - PubMed

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