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. 2024 Dec;30(6):812-818.
doi: 10.1177/15910199241287417. Epub 2024 Oct 3.

Jugular venous narrowing and spontaneous spinal cerebrospinal fluid leaks: A case-control study exploring association and proposed mechanism

Sasicha Manupipatpong  1 , Christopher T Primiani  2 , Kyle M Fargen  3 , Matthew R Amans  4 , Linda Leithe  5 , Wouter I Schievink  6 , Mark G Luciano  7 , Ferdinand K Hui  1
Affiliations

Jugular venous narrowing and spontaneous spinal cerebrospinal fluid leaks: A case-control study exploring association and proposed mechanism

Sasicha Manupipatpong et al. Interv Neuroradiol. 2024 Dec.

Abstract

Background: Spontaneous skull base cerebrospinal fluid leaks (CSFLs) are associated with increased intracranial pressure in idiopathic intracranial hypertension (IIH) and hypothesized to relate to skull base erosions due to increased CSF pressure. Given the increasing recognition of internal jugular venous stenosis (IJVS) as a cause of intracranial hypertension (IH), we evaluated the relationship between spinal CSFL and venous causes of IH.

Methods: The spinal CSFL database at a single institution was assessed to identify 12 consecutive spontaneous, non-traumatic spinal CSFL patients with CTV data. Exclusion criteria included documented IIH and iatrogenic CSFL. Demographics, clinical parameters, imaging characteristics, and IJV manometry results were recorded. Internal jugular venous stenosis was graded as: none (0-10%), mild (10-50%), moderate (50-80%), severe (>80-99%), and occluded (100%). Twelve consecutive patients who presented with cerebrovascular accidents without CSFL, matched by age and sex, were similarly analyzed as a control group. STROBE guidelines were used in reporting results.

Results: All CSFL patients had IJVS (83.3% bilateral, 33.3% severe) compared to 41.7% of the control group (33.3% bilateral, 16.7% severe-occluded); p = 0.04. All CSFL patients with available venogram manometry data had at least unilateral IJV gradients. Most patients presented with modified Rankin score (mRS) of 1 (66.7%), but in those with higher mRS, medical and/or surgical interventions were associated with decreased morbidity.

Conclusion: Spontaneous spinal CSFL was associated with IJVS in patients not meeting IIH criteria. Persistently high CSF pressure resulting in CSFL may cause opening pressure to be falsely normal or low. Internal jugular venous stenosis may be a viable target in recurrent CSFL management and improve morbidity.

Keywords: Cerebrospinal fluid leak; intracranial hypertension; jugular venous stenosis.

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Conflict of interest statement

Author contributionsFH and CP contributed to the design of the research and collection of data. SM contributed to the collection of data, analysis of the results, and writing of the manuscript, with input/contribution from KF, MA, LG, WS, ML, and FH. Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CTV demonstrating bilateral severe IJV stenosis. Right IJV extrinsically compressed between (a) transverse process of C1 and (b) posterior belly of the digastric muscle. Left IJV extrinsically compressed at C1–C2 (c).
Figure 2.
Figure 2.
CTV showing mild bilateral IJV stenosis. Extrinsic IJV compression by the styloid processes on both the right (a, c) and left (b), unchanged with flexion (d) or extension (e).
See this image and copyright information in PMC

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