To demonstrate the spectrum of imaging findings and treatment options for CSF leaks including the relatively novel type-3 leak.

Non-iatrogenic cerebrospinal fluid (CSF) leaks at the spinal level can lead to spontaneous spinal intracranial hypotension (SSIH) which can be a severely disabling condition due to the symptoms including orthostatic headaches, dizziness, nausea/vomiting, and tinnitus.1-2 There are 4 described CSF leaks. Type-1 leaks can be attributed to ventral tears of the spinal dura from degenerative disc disease.3-4 Type-2 leaks feature a more lateral proximal nerve root sleeve tear.3-4 Type-3 leak is the result of drainage of CSF into the venous system via a CSF-venous fistula...

Spinal imaging is performed to look for a spinal longitudinal extradural CSF collection (SLEC) and in some instances can demonstrate the dural defect.2-4,7 Traditionally T2-weighted MRI or conventional CT myelography are used in the first instance due to its high sensitivity.3,7 Newer targeted imaging techniques, including heavily T2-weighted MRI, digital subtraction myelography (DSM) and dynamic CT myelography and MR myelography have improved identification of CSF leaks.3,7 Type-3 leaks are difficult to detect on heavily weighted T2-MR imaging due to absence of CSF in the epidural...

Non-iatrogenic CSF leaks can be challenging to diagnose. We present the multimodality imaging spectrum of CSF leaks along with image guided treatment options which can significantly improve the symptoms of SSIH.

[1] Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.Jama. 2006 May 17;295(19):2286-96. [2] Schievink WI, Maya MM, Louy C, Moser FG, Tourje J. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. American journal of neuroradiology. 2008 May 1;29(5):853-6. [3] Farb RI, Nicholson PJ, Peng PW, Massicotte EM, Lay C, Krings T. Spontaneous intracranial hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography. American Journal of Neuroradiology. 2019 Apr 1;40(4):745-53. [4] Schievink WI,...