{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:12:40Z","timestamp":1791274360949,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pediatric spinal CSF leaks are uncommon and encompass a spectrum of leak types with distinct imaging findings, diagnostic pathways, and treatment strategies. Brain and spine MRI guide the evaluation of suspected CSF leaks and the selection of advanced imaging techniques for precise leak localization. Leak types include dural tears, CSF-venous fistulas, and CSF-vascular malformation fistulas, each with distinct imaging and treatment considerations. This pictorial review illustrates the spectrum of pediatric spinal CSF leaks and provides a practical framework for their diagnosis and management.<\/jats:p>","DOI":"10.1007\/s00247-026-06764-2","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:16:03Z","timestamp":1788344163000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Detecting the drip: pediatric neuroradiologist guide to spinal CSF leaks"],"prefix":"10.1007","author":[{"given":"Mark D.","family":"Mamlouk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"6764_CR1","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.3174\/ajnr.A8484","volume":"45","author":"MD Mamlouk","year":"2024","unstructured":"Mamlouk MD, Callen AL, Madhavan AA et al (2024) Spinal CSF leaks: the neuroradiologist transforming care. AJNR Am J Neuroradiol 45:1613\u20131620","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR2","doi-asserted-by":"publisher","first-page":"2173","DOI":"10.1056\/NEJMra2101561","volume":"385","author":"WI Schievink","year":"2021","unstructured":"Schievink WI (2021) Spontaneous intracranial hypotension. N Engl J Med 385:2173\u20132178","journal-title":"N Engl J Med"},{"key":"6764_CR3","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.a9421","author":"AL Callen","year":"2026","unstructured":"Callen AL, Jenkins K, Bhaumik D et al (2026) When orthostatic headache misleads: positional headache phenotypes across spinal CSF leak types and implications for patients without SIH findings on brain MRI. AJNR Am J Neuroradiol. https:\/\/doi.org\/10.3174\/ajnr.a9421","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR4","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1227\/ons.0000000000000914","volume":"26","author":"L H\u00e4ni","year":"2024","unstructured":"H\u00e4ni L, Fung C, El Rahal A et al (2024) Distinct pattern of membrane formation with spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension. Oper Neurosurg (Hagerstown, Md) 26:71\u201377","journal-title":"Oper Neurosurg (Hagerstown, Md)"},{"key":"6764_CR5","doi-asserted-by":"publisher","first-page":"2693","DOI":"10.3174\/ajnr.A8856","volume":"46","author":"MD Mamlouk","year":"2025","unstructured":"Mamlouk MD, Zamary AR, L\u00fctzen N et al (2025) Decubitus myelography for spinal extradural arachnoid cyst: better classified as a lateral dural CSF leak? AJNR Am J Neuroradiol 46:2693\u20132696","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR6","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1177\/03331024211048510","volume":"42","author":"WI Schievink","year":"2022","unstructured":"Schievink WI, Maya MM, Moser FG et al (2022) Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006\u20132020. Cephalalgia 42:312\u2013316","journal-title":"Cephalalgia"},{"key":"6764_CR7","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.3174\/ajnr.A8430","volume":"45","author":"AA Madhavan","year":"2024","unstructured":"Madhavan AA, Kranz PG, Carlton Jones L et al (2024) Spontaneous intracranial hypotension in children: a multi-institutional review of spinal CSF leaks localized on advanced myelography. AJNR Am J Neuroradiol 45:1921\u20131927","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR8","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.3174\/ajnr.A7548","volume":"43","author":"MD Mamlouk","year":"2022","unstructured":"Mamlouk MD, Shen PY, Jun P, Sedrak MF (2022) Spontaneous spinal CSF leaks stratified by age, body mass index, and spinal level. AJNR Am J Neuroradiol 43:1068\u20131072","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR9","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.jpeds.2013.01.055","volume":"163","author":"WI Schievink","year":"2013","unstructured":"Schievink WI, Maya MM, Louy C et al (2013) Spontaneous intracranial hypotension in childhood and adolescence. J Pediatr 163:504\u2013510","journal-title":"J Pediatr"},{"key":"6764_CR10","doi-asserted-by":"publisher","first-page":"426","DOI":"10.3174\/ajnr.A8471","volume":"46","author":"MD Mamlouk","year":"2025","unstructured":"Mamlouk MD, Gutierrez A, Dillon WP (2025) Spontaneous intracranial hypotension associated with vascular malformations. AJNR Am J Neuroradiol 46:426\u2013432","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR11","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.3174\/ajnr.A9017","volume":"46","author":"PG Kranz","year":"2025","unstructured":"Kranz PG, Amrhein TJ, Brinjikji W et al (2025) Consensus guidelines on diagnostic brain and spine imaging of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 46:2457\u20132467","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR12","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3174\/ajnr.A8165","volume":"45","author":"WI Schievink","year":"2024","unstructured":"Schievink WI, Maya MM, Tay ASS et al (2024) Optic nerve sheath MR imaging measurements in patients with orthostatic headaches and normal findings on conventional imaging predict the presence of an underlying CSF-venous fistula. AJNR Am J Neuroradiol 45:655\u2013661","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR13","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1136\/jnis-2024-022957","volume":"18","author":"F Cagnazzo","year":"2026","unstructured":"Cagnazzo F, Le Bars E, Risi G et al (2026) Early brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension. J Neurointerv Surg 18:442\u2013449","journal-title":"J Neurointerv Surg"},{"key":"6764_CR14","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.3174\/ajnr.A0621","volume":"28","author":"RI Farb","year":"2007","unstructured":"Farb RI, Forghani R, Lee SK et al (2007) The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol 28:1489\u20131493","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR15","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1001\/jamaneurol.2018.4921","volume":"76","author":"T Dobrocky","year":"2019","unstructured":"Dobrocky T, Grunder L, Breiding PS et al (2019) Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol 76:580\u2013587","journal-title":"JAMA Neurol"},{"key":"6764_CR16","doi-asserted-by":"publisher","first-page":"341","DOI":"10.3174\/ajnr.A7784","volume":"44","author":"MD Mamlouk","year":"2023","unstructured":"Mamlouk MD, Shen PY, Dahlin BC (2023) Modified dynamic CT myelography for type 1 and 2 CSF leaks: a procedural approach. AJNR Am J Neuroradiol 44:341\u2013346","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR17","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3174\/ajnr.A6844","volume":"42","author":"MD Mamlouk","year":"2021","unstructured":"Mamlouk MD, Ochi RP, Jun P et al (2021) Decubitus CT myelography for CSF-venous fistulas: a procedural approach. AJNR Am J Neuroradiol 42:32\u201336","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR18","doi-asserted-by":"publisher","first-page":"645","DOI":"10.3174\/ajnr.A7476","volume":"43","author":"L Carlton Jones","year":"2022","unstructured":"Carlton Jones L, Goadsby PJ (2022) Same-day bilateral decubitus CT myelography for detecting CSF-venous fistulas in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 43:645\u2013648","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR19","unstructured":"OMNIPAQUE\u2122 (iohexol) Injection Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/018956s099lbl.pdf. Accessed May 30, 2026"},{"key":"6764_CR20","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.3174\/ajnr.A9091","volume":"47","author":"CM Garcia","year":"2026","unstructured":"Garcia CM, Chang D, Maya MM et al (2026) Under pressure: advancing the diagnosis of pediatric CSF leaks with digital subtraction myelography. AJNR Am J Neuroradiol 47:1135\u20131140","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/B978-0-444-64189-2.00002-0","volume":"155","author":"C Raybaud","year":"2018","unstructured":"Raybaud C, Jallo GI (2018) Chiari 1 deformity in children: etiopathogenesis and radiologic diagnosis. Handb Clin Neurol 155:25\u201348","journal-title":"Handb Clin Neurol"},{"key":"6764_CR22","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.3171\/2021.6.JNS211010","volume":"136","author":"JL Houk","year":"2022","unstructured":"Houk JL, Amrhein TJ, Gray L et al (2022) Differentiation of Chiari malformation type 1 and spontaneous intracranial hypotension using objective measurements of midbrain sagging. J Neurosurg 136:1796\u20131803","journal-title":"J Neurosurg"},{"key":"6764_CR23","doi-asserted-by":"publisher","first-page":"e268","DOI":"10.1016\/j.wneu.2020.07.108","volume":"143","author":"EH Middlebrooks","year":"2020","unstructured":"Middlebrooks EH, Okromelidze L, Vilanilam GK et al (2020) Syrinx secondary to Chiari-like tonsillar herniation in spontaneous intracranial hypotension. World Neurosurg 143:e268\u2013e274","journal-title":"World Neurosurg"},{"key":"6764_CR24","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.nic.2024.08.006","volume":"35","author":"MD Mamlouk","year":"2025","unstructured":"Mamlouk MD (2025) Image-guided epidural blood patching and fibrin glue occlusion of cerebrospinal fluid leaks and venous fistulas. Neuroimaging Clin N Am 35:143\u2013154","journal-title":"Neuroimaging Clin N Am"},{"key":"6764_CR25","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.3174\/ajnr.A4842","volume":"37","author":"TJ Amrhein","year":"2016","unstructured":"Amrhein TJ, Befera NT, Gray L, Kranz PG (2016) CT fluoroscopy-guided blood patching of ventral CSF leaks by direct needle placement in the ventral epidural space using a transforaminal approach. AJNR Am J Neuroradiol 37:1951\u20131956","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR26","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1213\/ANE.0b013e318218204d","volume":"113","author":"MJ Paech","year":"2011","unstructured":"Paech MJ, Doherty DA, Christmas T, Wong CA (2011) The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg 113:126\u2013133","journal-title":"Anesth Analg"},{"key":"6764_CR27","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.a9216","author":"A Bani-Sadr","year":"2026","unstructured":"Bani-Sadr A, Gu\u00e9rin A, Froment Tilikete C et al (2026) Safety and efficacy of intracystic fibrin glue injection for CSF-venous fistulas. AJNR Am J Neuroradiol. https:\/\/doi.org\/10.3174\/ajnr.a9216","journal-title":"AJNR Am J Neuroradiol"},{"key":"6764_CR28","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2021204231","author":"MD Mamlouk","year":"2021","unstructured":"Mamlouk MD, Shen PY, Sedrak MF, Dillon WP (2021) CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas. Radiology. https:\/\/doi.org\/10.1148\/radiol.2021204231","journal-title":"Radiology"},{"key":"6764_CR29","doi-asserted-by":"publisher","DOI":"10.1177\/15910199241247698","author":"F Cagnazzo","year":"2024","unstructured":"Cagnazzo F, Ducros A, Risi G et al (2024) Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension. Interv Neuroradiol. https:\/\/doi.org\/10.1177\/15910199241247698","journal-title":"Interv Neuroradiol"}],"container-title":["Pediatric Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06764-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00247-026-06764-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06764-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:16:04Z","timestamp":1788344164000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00247-026-06764-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":29,"alternative-id":["6764"],"URL":"https:\/\/doi.org\/10.1007\/s00247-026-06764-2","relation":{},"ISSN":["1432-1998"],"issn-type":[{"value":"1432-1998","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]},"assertion":[{"value":"15 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This work was conducted in accordance with the ethical principles of the Declaration of Helsinki and with applicable institutional policies governing human subjects research. This study was approved by the Kaiser Permanente Northern California Institutional Review Board (The Permanente Medical Group). The requirement for informed consent was waived by the Kaiser Permanente Northern California Institutional Review Board because the study involved retrospective review of de-identified clinical data and images without protected health information.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None","order":2,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}