title: A classification system of spontaneous spinal CSF leaks.
abstract: OBJECTIVE
  Spontaneous spinal CSF leaks cause spontaneous intracranial hypotension but no systematic study of the different types of these CSF leaks has been reported. Based on our experience with spontaneous intracranial hypotension, we propose a classification system of spontaneous spinal CSF leaks.
  
  
  METHODS
  We reviewed the medical records, radiographic studies, operative notes, and any intraoperative photographs of a group of consecutive patients with spontaneous intracranial hypotension.
  
  
  RESULTS
  The mean age of the 568 patients (373 [65.7%] women) was 45.7 years. Three types of CSF leak could be identified. Type 1 CSF leaks consisted of a dural tear (151 patients [26.6%]) and these were almost exclusively associated with an extradural CSF collection. Type 1a represented ventral CSF leaks (96%) and type 1b posterolateral CSF leaks (4%). Type 2 CSF leaks consisted of meningeal diverticula (240 patients [42.3%]) and were the source of an extradural CSF collection in 53 of these patients (22.1%). Type 2a represented simple diverticula (90.8%) and type 2b complex meningeal diverticula/dural ectasia (9.2%). Type 3 CSF leaks consisted of direct CSF-venous fistulas (14 patients [2.5%]) and these were not associated with extradural CSF collections. A total of 163 patients (28.7%) had an indeterminate type and extradural CSF collections were noted in 84 (51.5%) of these patients.
  
  
  CONCLUSIONS
  We identified 3 types of spontaneous spinal CSF leak in this observational study: the dural tear, the meningeal diverticulum, and the CSF-venous fistula. These 3 types and the presence or absence of extradural CSF form the basis of a comprehensive classification system.
authors.affiliation: From the Departments of Neurosurgery (W.I.S., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., 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., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., 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., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Jean-Pierre
authors.affiliation: From the Departments of Neurosurgery (W.I.S., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: From the Departments of Neurosurgery (W.I.S., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Prasad
authors.affiliation: From the Departments of Neurosurgery (W.I.S., S.J.-P., M.N.) and Radiology (M.M.M., R.S.P., F.G.M.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Moser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000145:classification* / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult