Cerebrospinal fluid outflow resistance as a diagnostic marker of spontaneous cerebrospinal fluid leakage.

Beck, Jürgen; Fung, Christian; Ulrich, Christian Thomas; Fiechter, Michael; Fichtner, Jens; Mattle, Heinrich; Mono, Marie-Luise; Meier, Niklaus; Mordasini, Pasquale; Z'Graggen, Werner Josef; Gralla, Jan; Raabe, Andreas (2017). Cerebrospinal fluid outflow resistance as a diagnostic marker of spontaneous cerebrospinal fluid leakage. Journal of neurosurgery - spine, 27(2), pp. 227-234. American Association of Neurological Surgeons 10.3171/2017.1.SPINE16548

[img] Text
2017.1.spine16548.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (6MB) | Request a copy

OBJECTIVE Spinal CSF leakage causes spontaneous intracranial hypotension (SIH). The aim of this study was to characterize CSF dynamics via lumbar infusion testing in patients with and without proven spinal CSF leakage in order to explore possible discriminators for the presence of an open CSF leak. METHODS This analysis included all patients with suspected SIH who were treated at the authors' institution between January 2012 and February 2015. The gold standard for "proven" CSF leakage is considered to be extrathecal contrast accumulation after intrathecal contrast injection. To characterize CSF dynamics, the authors performed computerized lumbar infusion testing to measure lumbar pressure at baseline (opening pressure) and at plateau, as well as pulse amplitude, CSF outflow resistance (RCSF), craniospinal elastance, and pressure-volume index. RESULTS Thirty-one patients underwent clinical imaging and lumbar infusion testing and were included in the final analysis. A comparison of the 14 patients with proven CSF leakage with the 17 patients without leakage showed a statistically significantly lower lumbar opening pressure (p < 0.001), plateau pressure (p < 0.001), and RCSF (p < 0.001) in the group with leakage. Sensitivity, specificity, and positive and negative predictive values for an RCSF cutoff of ≤ 5 mm Hg/(ml/min) were 0.86, 1.0, 1.0, and 0.89 (area under the curve of 0.96), respectively. The median pressure-volume index was higher (p = 0.003), and baseline (p = 0.017) and plateau (p < 0.001) pulse amplitudes were lower in patients with a proven leak. CONCLUSIONS Lumbar infusion testing captures a distinct pattern of CSF dynamics associated with spinal CSF leakage. RCSF assessed by computerized lumbar infusion testing has an excellent diagnostic accuracy and is more accurate than evaluating the lumbar opening pressure. The authors suggest inclusion of RCSF in the diagnostic criteria for SIH.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Beck, Jürgen, Fung, Christian, Ulrich, Christian Thomas (A), Fiechter, Michael, Fichtner, Jens, Mattle, Heinrich, Mono, Marie-Luise, Meier, Niklaus, Mordasini, Pasquale Ranato, Z'Graggen, Werner Josef, Gralla, Jan, Raabe, Andreas


600 Technology > 610 Medicine & health




American Association of Neurological Surgeons




Martin Zbinden

Date Deposited:

08 Aug 2017 07:48

Last Modified:

29 Mar 2023 23:35

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

AUC = area under the curve; CSF outflow resistance; ICHD = International Classification of Headache Disorders; ICP = intracranial pressure; IQR = interquartile range; PVI = pressure-volume index; RCSF = CSF outflow resistance; ROC = receiver operating characteristic; SIH = spontaneous intracranial hypotension; headache; lumbar infusion test; spinal cerebrospinal fluid leak; spontaneous intracranial hypotension; surgical technique





Actions (login required)

Edit item Edit item
Provide Feedback