title: False localizing sign of cervico-thoracic CSF leak in spontaneous intracranial hypotension.
abstract: OBJECTIVE
  Spontaneous spinal CSF leaks are an important cause of new-onset headaches. Such leaks are reported to be particularly common at the cervico-thoracic junction. The authors undertook a study to determine the significance of these cervico-thoracic CSF leaks.
  
  
  METHODS
  The patient population consisted of a consecutive group of 13 patients who underwent surgery for CSF leak repair based on CT myelography showing CSF extravasation at the cervico-thoracic junction but without any evidence of an underlying structural lesion.
  
  
  RESULTS
  The mean age of the 9 women and 4 men was 41.2 years. Extensive extrathecal longitudinal CSF collections were demonstrated in 11 patients. At surgery, small leaking arachnoid cysts were found in 2 patients. In the remaining 11 patients, no clear source of CSF leakage could be identified at surgery. Resolution of symptoms was achieved in both patients with leaking arachnoid cysts, but in only 3 of the 11 patients with negative intraoperative findings. Postoperative spinal imaging was performed in 9 of the 11 patients with negative intraoperative findings and showed persistence of the longitudinal intraspinal extradural CSF. Further imaging revealed the site of the CSF leak to be ventral to the thoracic spinal cord. Five of these patients underwent microsurgical repair of the ventral CSF leak with resolution of symptoms in all 5 patients.
  
  
  CONCLUSIONS
  Cervico-thoracic extravasation of dye on myelography does not necessarily indicate the site of the CSF leak. Treatment directed at this site should not be expected to have a high probability of sustained improvement of symptoms.
authors.affiliation: From the Departments of Neurosurgery (W.I.S., R.M.C.) and Radiology (M.M.M., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA. schievinkw@cshs.org.
authors.forename: Wouter I
authors.initials: WI
authors.lastname: Schievink
authors.affiliation: From the Departments of Neurosurgery (W.I.S., R.M.C.) and Radiology (M.M.M., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: M Marcel
authors.initials: MM
authors.lastname: Maya
authors.affiliation: From the Departments of Neurosurgery (W.I.S., R.M.C.) and Radiology (M.M.M., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Ray M
authors.initials: RM
authors.lastname: Chu
authors.affiliation: From the Departments of Neurosurgery (W.I.S., R.M.C.) and Radiology (M.M.M., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Moser
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D004388:Dura Mater; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D013353:Subdural Effusion / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed