{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:03Z","timestamp":1776096423015,"version":"3.50.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>CSF-venous fistulas (CVFs) are abnormal connections between the spinal subarachnoid space and the adjacent venous plexus. They are typically treated by surgical disconnection, transvenous embolization, or percutaneous therapies such as epidural fibrin glue injection or blood patches that are known to be less effective for full resolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Here, the authors report a case of intracranial hypotension due to a spinal CVF that spontaneously resolved after a diagnostic spinal myelogram in the right lateral decubitus position. One hypothesis for this unique observation is the high viscosity of the contrast agent used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>CVFs can potentially resolve spontaneously after high-volume CSF drainage during a diagnostic spinal myelogram due to the high viscosity of contrast material in addition to a decrease in transfistula gradient.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25194\">https:\/\/thejns.org\/doi\/10.3171\/CASE25194<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25194","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:09Z","timestamp":1775642649000},"source":"Crossref","is-referenced-by-count":0,"title":["Resolution of spontaneous intracranial hypotension due to a spinal CSF-venous fistula after a dynamic myelogram: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2328-7873","authenticated-orcid":true,"given":"Natalie J.","family":"Bales","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-6862","authenticated-orcid":true,"given":"Ivo","family":"Peto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal","family":"Vakharia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Hayman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"bib1","series-title":"Neurology","first-page":"472","article-title":"CSF-venous fistula in spontaneous intracranial hypotension","volume":"83","author":"Schievink","year":"2014","unstructured":"Schievink WIMoser FGMaya MM.CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 2014;83(5):472-473. doi:10.1212\/WNL.0000000000000639"},{"issue":"5","key":"bib2","series-title":"JAMA Neurol","first-page":"580","article-title":"Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings","volume":"76","author":"Dobrocky","year":"2019","unstructured":"Dobrocky TGrunder LBreiding PSAssessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 2019;76(5):580-587. doi:10.1001\/jamaneurol.2018.4921"},{"issue":"6","key":"bib3","series-title":"AJR Am J Roentgenol","first-page":"1360","article-title":"CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography","volume":"209","author":"Kranz","year":"2017","unstructured":"Kranz PGAmrhein TJGray L.CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol. 2017;209(6):1360-1366. doi:10.2214\/AJR.17.18351"},{"issue":"5","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"882","article-title":"A novel endovascular therapy for CSF hypotension secondary to CSF-venous fistulas","volume":"42","author":"Brinjikji","year":"2021","unstructured":"Brinjikji WSavastano LEAtkinson JLDGarza IFarb RCutsforth-Gregory JK.A novel endovascular therapy for CSF hypotension secondary to CSF-venous fistulas. AJNR Am J Neuroradiol. 2021;42(5):882-887. doi:10.3174\/ajnr.A7014"},{"issue":"2","key":"bib5","series-title":"Radiology","first-page":"409","article-title":"CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas","volume":"299","author":"Mamlouk","year":"2021","unstructured":"Mamlouk MDShen PYSedrak MFDillon WP.CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas. Radiology. 2021;299(2):409-418. doi:10.1148\/radiol.2021204231"},{"issue":"8","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"1489","article-title":"The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain","volume":"28","author":"Farb","year":"2007","unstructured":"Farb RIForghani RLee SKMikulis DJAgid R.The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol. 2007;28(8):1489-1493. doi:10.3174\/ajnr.A0621"},{"issue":"7","key":"bib7","series-title":"Neurology","first-page":"673","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","unstructured":"Schievink WIMaya MMJean-Pierre SNu\u00f1o MPrasad RSMoser FG.A classification system of spontaneous spinal CSF leaks. Neurology. 2016;87(7):673-679. doi:10.1212\/WNL.0000000000002986"},{"issue":"2","key":"bib8","series-title":"Cephalalgia","first-page":"323","article-title":"Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension","volume":"38","author":"Choi","year":"2018","unstructured":"Choi HLee MJChoi HACha JChung CS.Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension. Cephalalgia. 2018;38(2):323-331. doi:10.1177\/0333102417690106"},{"issue":"3","key":"bib9","series-title":"Headache","first-page":"229","article-title":"Beyond myths: transformative insights into spinal cerebrospinal fluid leaks and their role in persistent headache syndromes","volume":"64","author":"Carroll","year":"2024","unstructured":"Carroll ICallen AL.Beyond myths: transformative insights into spinal cerebrospinal fluid leaks and their role in persistent headache syndromes. Headache. 2024;64(3):229-232. doi:10.1111\/head.14677"},{"issue":"9","key":"bib10","series-title":"AJNR Am J Neuroradiol","first-page":"1754","article-title":"Respiratory phase affects the conspicuity of CSF-venous fistulas in spontaneous intracranial hypotension","volume":"41","author":"Amrhein","year":"2020","unstructured":"Amrhein TJGray LMalinzak MDKranz PG.Respiratory phase affects the conspicuity of CSF-venous fistulas in spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2020;41(9):1754-1756. doi:10.3174\/ajnr.A6663"},{"issue":"10","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1403","article-title":"Myelographic techniques for the localization of CSF-venous fistulas: updates in 2024","volume":"45","author":"Madhavan","year":"2024","unstructured":"Madhavan AABrinjikji WCutsforth-Gregory JKMyelographic techniques for the localization of CSF-venous fistulas: updates in 2024. AJNR Am J Neuroradiol. 2024;45(10):1403-1412. doi:10.3174\/ajnr.A8299"},{"issue":"5","key":"bib1","series-title":"Neurology","first-page":"472","article-title":"CSF-venous fistula in spontaneous intracranial hypotension","volume":"83","author":"Schievink","year":"2014","unstructured":"Schievink WIMoser FGMaya MM.CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 2014;83(5):472-473. doi:10.1212\/WNL.0000000000000639"},{"issue":"5","key":"bib2","series-title":"JAMA Neurol","first-page":"580","article-title":"Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings","volume":"76","author":"Dobrocky","year":"2019","unstructured":"Dobrocky TGrunder LBreiding PSAssessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 2019;76(5):580-587. doi:10.1001\/jamaneurol.2018.4921"},{"issue":"6","key":"bib3","series-title":"AJR Am J Roentgenol","first-page":"1360","article-title":"CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography","volume":"209","author":"Kranz","year":"2017","unstructured":"Kranz PGAmrhein TJGray L.CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol. 2017;209(6):1360-1366. doi:10.2214\/AJR.17.18351"},{"issue":"5","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"882","article-title":"A novel endovascular therapy for CSF hypotension secondary to CSF-venous fistulas","volume":"42","author":"Brinjikji","year":"2021","unstructured":"Brinjikji WSavastano LEAtkinson JLDGarza IFarb RCutsforth-Gregory JK.A novel endovascular therapy for CSF hypotension secondary to CSF-venous fistulas. AJNR Am J Neuroradiol. 2021;42(5):882-887. doi:10.3174\/ajnr.A7014"},{"issue":"2","key":"bib5","series-title":"Radiology","first-page":"409","article-title":"CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas","volume":"299","author":"Mamlouk","year":"2021","unstructured":"Mamlouk MDShen PYSedrak MFDillon WP.CT-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas. Radiology. 2021;299(2):409-418. doi:10.1148\/radiol.2021204231"},{"issue":"8","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"1489","article-title":"The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain","volume":"28","author":"Farb","year":"2007","unstructured":"Farb RIForghani RLee SKMikulis DJAgid R.The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol. 2007;28(8):1489-1493. doi:10.3174\/ajnr.A0621"},{"issue":"7","key":"bib7","series-title":"Neurology","first-page":"673","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","unstructured":"Schievink WIMaya MMJean-Pierre SNu\u00f1o MPrasad RSMoser FG.A classification system of spontaneous spinal CSF leaks. Neurology. 2016;87(7):673-679. doi:10.1212\/WNL.0000000000002986"},{"issue":"2","key":"bib8","series-title":"Cephalalgia","first-page":"323","article-title":"Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension","volume":"38","author":"Choi","year":"2018","unstructured":"Choi HLee MJChoi HACha JChung CS.Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension. Cephalalgia. 2018;38(2):323-331. doi:10.1177\/0333102417690106"},{"issue":"3","key":"bib9","series-title":"Headache","first-page":"229","article-title":"Beyond myths: transformative insights into spinal cerebrospinal fluid leaks and their role in persistent headache syndromes","volume":"64","author":"Carroll","year":"2024","unstructured":"Carroll ICallen AL.Beyond myths: transformative insights into spinal cerebrospinal fluid leaks and their role in persistent headache syndromes. Headache. 2024;64(3):229-232. doi:10.1111\/head.14677"},{"issue":"9","key":"bib10","series-title":"AJNR Am J Neuroradiol","first-page":"1754","article-title":"Respiratory phase affects the conspicuity of CSF-venous fistulas in spontaneous intracranial hypotension","volume":"41","author":"Amrhein","year":"2020","unstructured":"Amrhein TJGray LMalinzak MDKranz PG.Respiratory phase affects the conspicuity of CSF-venous fistulas in spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2020;41(9):1754-1756. doi:10.3174\/ajnr.A6663"},{"issue":"10","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1403","article-title":"Myelographic techniques for the localization of CSF-venous fistulas: updates in 2024","volume":"45","author":"Madhavan","year":"2024","unstructured":"Madhavan AABrinjikji WCutsforth-Gregory JKMyelographic techniques for the localization of CSF-venous fistulas: updates in 2024. 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