PT  - JOURNAL ARTICLE
AU  - Caton, M.T.
AU  - Laguna, B.
AU  - Soderlund, K.A.
AU  - Dillon, W.P.
AU  - Shah, V.N.
TI  - Spinal Compliance Curves: Preliminary Experience with a New Tool for Evaluating Suspected CSF Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension
AID  - 10.3174/ajnr.A7018
DP  - 2021 May 01
TA  - American Journal of Neuroradiology
PG  - 986--992
VI  - 42
IP  - 5
4099  - http://www.ajnr.org/content/42/5/986.short
4100  - http://www.ajnr.org/content/42/5/986.full
SO  - Am. J. Neuroradiol.2021 May 01; 42
AB  - BACKGROUND AND PURPOSE: Craniospinal space compliance reflects the distensibility of the spinal and intracranial CSF spaces as a system. Craniospinal space compliance has been studied in intracranial pathologies, but data are limited in assessing it in spinal CSF leak. This study describes a method to estimate craniospinal space compliance using saline infusion during CT myelography and explores the use of craniospinal space compliance and pressure-volume curves in patients with suspected cerebrospinal-venous fistula.MATERIALS AND METHODS: Patients with suspected cerebrospinal-venous fistula underwent dynamic CT myelography. During the procedure, 1- to 5-mL boluses of saline were infused, and incremental changes in CSF pressure were recorded. These data were used to plot craniospinal space compliance curves. We calculated 3 quantitative craniospinal space compliance parameters: overall compliance, compliance at opening pressure, and the pressure volume index. These variables were compared between patients with confirmed cerebrospinal-venous fistula and those with no confirmed source of CSF leak.RESULTS: Thirty-four CT myelograms in 22 patients were analyzed. Eight of 22 (36.4%) patients had confirmed cerebrospinal-venous fistulas. Bolus infusion was well-tolerated with no complications and transient headache in 2/34 (5.8%). Patients with confirmed cerebrospinal-venous fistulas had higher compliance at opening pressure and overall compliance (2.6 versus 1.8 mL/cm H20, P < .01). There was no difference in the pressure volume index (77.5 versus 54.3 mL, P = .13) between groups.CONCLUSIONS: A method of deriving craniospinal space compliance curves using saline intrathecal infusion is described. Preliminary analysis of craniospinal space compliance curves provides qualitative and quantitative information about pressure-volume dynamics and may serve as a diagnostic tool in patients with known or suspected cerebrospinal-venous fistulas.Copcompliance at opening pressureCSCcerebrospinal space complianceCTMCT myelographyCVFcerebrospinal-venous fistulaPVIpressure-volume indexSIHspontaneous intracranial hypotension