{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:46:35Z","timestamp":1792806395294,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the occurrence of cerebrospinal fluid (CSF)\u2010venous fistulas, a type of spinal CSF leak that cannot be detected with routine computerized tomography myelography, among patients with orthostatic headaches but normal brain and spine magnetic resonance imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spontaneous spinal CSF leaks cause orthostatic headaches but their detection may require sophisticated spinal imaging techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort study of patients with orthostatic headaches and normal brain and conventional spine imaging who underwent digital subtraction myelography (DSM) to look for CSF\u2010venous fistulas, between May 2018 and May 2020, at a quaternary referral center for spontaneous intracranial hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the 60 consecutive patients (46 women and 14 men) was 46\u00a0years (range, 13\u201383\u00a0years), who had been suffering from orthostatic headaches between 1 and 180\u00a0months (mean, 43\u00a0months). DSM demonstrated a spinal CSF\u2010venous fistula in 6 (10.0%; 95% confidence interval [CI]: 3.8\u201320.5%) of the 60 patients. The mean age of these five women and one man was 50\u00a0years (range, 41\u201359\u00a0years). Spinal CSF\u2010venous fistulas were identified in 6 (19.4%; 95% CI: 7.5\u201337.5%) of 31 patients with spinal meningeal diverticula but in none (0%; 95% CI: 0\u201311.9%) of the 29 patients without spinal meningeal diverticula (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.024). All CSF\u2010venous fistulas were located in the thoracic spine. All patients underwent uneventful surgical ligation of the fistula. Complete and sustained resolution of symptoms was obtained in five patients, while in one patient, partial recurrence of symptoms was noted 3\u00a0months postoperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Concerns about a spinal CSF leak should not be dismissed in patients suffering from orthostatic headaches when conventional imaging turns out to be normal, even though the yield of identifying a CSF\u2010venous fistula is low.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14048","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T05:35:30Z","timestamp":1611380130000},"page":"387-391","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Spontaneous spinal cerebrospinal fluid\u2010venous fistulas in patients with orthostatic headaches and normal conventional brain and spine imaging"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5494-0688","authenticated-orcid":false,"given":"Wouter I.","family":"Schievink","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Maya","sequence":"additional","affiliation":[{"name":"Department of Imaging Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi S.","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Imaging Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram S.","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Department of Imaging Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle B.","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin G.","family":"Moser","sequence":"additional","affiliation":[{"name":"Department of Imaging Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Nuno","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of California, Davis Davis CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1001\/jama.295.19.2286","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial 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hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography","volume":"40","author":"Farb RI","year":"2019","journal-title":"Am J Neuroradiol"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1177\/0333102419881673","article-title":"Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid\u2010venous fistula: case series","volume":"39","author":"Duvall JR","year":"2019","journal-title":"Cephalalgia"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3171\/2019.6.SPINE19487","article-title":"Lateral decubitus digital subtraction myelography to identify spinal CSF\u2010venous fistulas in spontaneous intracranial hypotension","volume":"31","author":"Schievink WI","year":"2019","journal-title":"J Neurosurg 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