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Nineteen patients with spontaneous intracranial hypotension with a proved spinal CSF leak were investigated between July 2014 and 2017. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated. The authors conclude that the study demonstrated a significant increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach, and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.