{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:36Z","timestamp":1776096396158,"version":"3.50.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"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":[[2026,2,16]]},"abstract":"\n BACKGROUND<\/jats:title>\n Spontaneous intracranial hypotension (SIH) may result in positional headaches, tinnitus, vestibular symptoms, and cognitive dysfunction. Pachymeningeal enhancement may be seen on contrast-enhancing imaging. Notably, the time course of pachymeningeal enhancement resolution has previously been shown to resolve within 17 hours of surgical repair. The authors sought to determine whether radiographic stigmata of SIH could be used as a marker for effective treatment.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A retrospective review of 14 patients who underwent open surgical management for SIH was conducted. Clinical notes and pre-and postoperative images were used to determine resolution of pachymeningeal enhancement. All patients experienced resolution of preoperative positional headaches on initial follow-up, with a median of 12 days following surgery. Diffuse pachymeningeal enhancement was found on preoperative MRI brain in all patients, with postoperative imaging showing resolution of pachymeningeal enhancement, with a median of 2 days postsurgery.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Diffuse pachymeningeal enhancement is a reliable marker for resolution SIH and often predates clinical resolution. Therefore, the authors propose that assessing for this characteristic with contrasted-brain MRI may assist in the posttreatment evaluation of patients with SIH.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25819<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25819","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:47:26Z","timestamp":1771847246000},"source":"Crossref","is-referenced-by-count":0,"title":["Resolution of pachymeningeal enhancement is a radiographic marker for effective treatment of spontaneous intracranial hypotension: patient series"],"prefix":"10.3171","volume":"11","author":[{"given":"Eric","family":"Esposito","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1150-0716","authenticated-orcid":true,"given":"Shenghua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Owolo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel N.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4883-914X","authenticated-orcid":true,"given":"Elie","family":"Massaad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Lavoie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Valery","family":"Coumans","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence F.","family":"Borges","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel","family":"Madan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart K.","family":"Chwalisz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5203-8619","authenticated-orcid":true,"given":"Ganesh M.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"23","key":"bib1","series-title":"N Engl J Med","first-page":"2173","article-title":"Spontaneous intracranial hypotension","volume":"385","author":"Schievink","year":"2021","unstructured":"Schievink WI.Spontaneous intracranial hypotension. N Engl J Med. 2021;385(23):2173-2178."},{"issue":"2","key":"bib2","series-title":"Pract Neurol","first-page":"98","article-title":"Spontaneous intracranial hypotension","volume":"24","author":"Cheema","year":"2024","unstructured":"Cheema SMehta DQureshi ASpontaneous intracranial hypotension. Pract Neurol. 2024;24(2):98-105."},{"issue":"1","key":"bib3","series-title":"BMJ Open","first-page":"e057438","article-title":"Patient experience of diagnosis and management of spontaneous intracranial hypotension: a cross-sectional online survey","volume":"12","author":"Cheema","year":"2022","unstructured":"Cheema SJoy CPople JSnape-Burns JTrevarthen TMatharu M.Patient experience of diagnosis and management of spontaneous intracranial hypotension: a cross-sectional online survey. BMJ Open. 2022;12(1):e057438."},{"issue":"4-5","key":"bib4","series-title":"Cephalalgia","first-page":"312","article-title":"Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020","volume":"42","author":"Schievink","year":"2022","unstructured":"Schievink WIMaya MMMoser FGSimon PNu\u00f1o M.Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020. Cephalalgia. 2022;42(4-5):312-316."},{"issue":"1","key":"bib5","series-title":"Cephalalgia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211."},{"issue":"5","key":"bib6","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."},{"key":"bib7","series-title":"Surg Neurol Int","first-page":"514","article-title":"Identification and surgical ligation of spinal CSF-venous fistula","volume":"12","author":"Majeed","year":"2021","unstructured":"Majeed KHanz SZRoytman MChazen JLGreenfield JP.Identification and surgical ligation of spinal CSF-venous fistula. Surg Neurol Int. 2021;12:514."},{"issue":"18","key":"bib8","series-title":"J Neurosurg Case Lessons","first-page":"CASE21730","article-title":"Minimally invasive surgery for spinal cerebrospinal fluid-venous fistula ligation: patient series","volume":"3","author":"Lohkamp","year":"2022","unstructured":"Lohkamp LNMarathe NNicholson PFarb RIMassicotte EM.Minimally invasive surgery for spinal cerebrospinal fluid-venous fistula ligation: patient series. J Neurosurg Case Lessons. 2022;3(18):CASE21730."},{"issue":"1","key":"bib9","series-title":"AJR Am J Roentgenol","first-page":"8","article-title":"Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension","volume":"206","author":"Kranz","year":"2016","unstructured":"Kranz PGLuetmer PHDiehn FEAmrhein TJTanpitukpongse TPGray L.Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;206(1):8-19."},{"issue":"27-28","key":"bib10","series-title":"Dtsch Arztebl Int","first-page":"480","article-title":"Spontaneous intracranial hypotension","volume":"117","author":"Urbach","year":"2020","unstructured":"Urbach HFung CDovi-Akue PL\u00fctzen NBeck J.Spontaneous intracranial hypotension. Dtsch Arztebl Int. 2020;117(27-28):480-487."},{"issue":"6","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1164","article-title":"Diffuse pachymeningeal hyperintensity and subdural effusion\/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension","volume":"29","author":"Tosaka","year":"2008","unstructured":"Tosaka MSato NFujimaki HDiffuse pachymeningeal hyperintensity and subdural effusion\/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2008;29(6):1164-1170."},{"issue":"8","key":"bib12","series-title":"Neurology","first-page":"1628","article-title":"Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI","volume":"42","author":"Hochman","year":"1992","unstructured":"Hochman MSNaidich TPKobetz SAFernandez-Maitin A.Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology. 1992;42(8):1628-1630."},{"issue":"4","key":"bib13","series-title":"Neurosurg Rev","first-page":"649","article-title":"Pachymeningeal enhancement-a comprehensive review of literature","volume":"38","author":"Antony","year":"2015","unstructured":"Antony JHacking CJeffree RL.Pachymeningeal enhancement-a comprehensive review of literature. Neurosurg Rev. 2015;38(4):649-659."},{"issue":"12","key":"bib14","series-title":"Neurology","first-page":"1746","article-title":"The Monro-Kellie hypothesis: applications in CSF volume depletion","volume":"56","author":"Mokri","year":"2001","unstructured":"Mokri B.The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology. 2001;56(12):1746-1748."},{"issue":"3","key":"bib15","series-title":"JAMA Neurol","first-page":"329","article-title":"Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis","volume":"78","author":"D\u2019Antona","year":"2021","unstructured":"D\u2019Antona LJaime Merchan MAVassiliou AClinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis. JAMA Neurol. 2021;78(3):329-337."},{"issue":"6","key":"bib16","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."},{"issue":"3","key":"bib17","series-title":"J Neurosurg","first-page":"475","article-title":"Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report","volume":"92","author":"Schievink","year":"2000","unstructured":"Schievink WITourje J.Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report. J Neurosurg. 2000;92(3):475-477."},{"issue":"6","key":"bib18","series-title":"AJR Am J Roentgenol","first-page":"1283","article-title":"Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension","volume":"207","author":"Kranz","year":"2016","unstructured":"Kranz PGAmrhein TJChoudhury KRTanpitukpongse TPGray L.Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;207(6):1283-1287."},{"issue":"3","key":"bib19","series-title":"Oper Neurosurg","first-page":"379","article-title":"Microsurgical repair of ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension: efficacy and safety of patch-sealing versus suturing","volume":"28","author":"Petutschnigg","year":"2024","unstructured":"Petutschnigg TH\u00e4ni LGoldberg JMicrosurgical repair of ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension: efficacy and safety of patch-sealing versus suturing. Oper Neurosurg. 2024;28(3):379-385."},{"issue":"3","key":"bib20","series-title":"Neurol Clin Pract","first-page":"e200290","article-title":"Diagnosis and treatment of spontaneous intracranial hypotension: role of epidural blood patching","volume":"14","author":"Callen","year":"2024","unstructured":"Callen ALFriedman DIParikh SDiagnosis and treatment of spontaneous intracranial hypotension: role of epidural blood patching. Neurol Clin Pract. 2024;14(3):e200290."},{"issue":"5","key":"bib21","series-title":"Neurol Clin Pract","first-page":"452","article-title":"Rapid onset and termination of neuroimaging findings in intracranial hypotension","volume":"3","author":"Rozen","year":"2013","unstructured":"Rozen TDSchievink WI.Rapid onset and termination of neuroimaging findings in intracranial hypotension. Neurol Clin Pract. 2013;3(5):452-453."},{"issue":"4","key":"bib22","series-title":"J Clin Epidemiol","first-page":"344","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","unstructured":"von Elm EAltman DGEgger MThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349."},{"issue":"7","key":"bib23","series-title":"AJNR Am J Neuroradiol","first-page":"1374","article-title":"Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure","volume":"37","author":"Kranz","year":"2016","unstructured":"Kranz PGTanpitukpongse TPChoudhury KRAmrhein TJGray L.Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure. AJNR Am J Neuroradiol. 2016;37(7):1374-1378."},{"issue":"5","key":"bib24","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."},{"issue":"3","key":"bib25","series-title":"Eur J Neurol","first-page":"947","article-title":"First-line steroid treatment for spontaneous intracranial hypotension","volume":"29","author":"Tonello","year":"2022","unstructured":"Tonello SGrossi UTrincia EZanus G.First-line steroid treatment for spontaneous intracranial hypotension. Eur J Neurol. 2022;29(3):947-949."},{"issue":"11","key":"bib26","series-title":"AJNR Am J Neuroradiol","first-page":"2055","article-title":"Monro-Kellie hypothesis: increase of ventricular CSF volume after surgical closure of a spinal dural leak in patients with spontaneous intracranial hypotension","volume":"41","author":"Dobrocky","year":"2020","unstructured":"Dobrocky TRebsamen MRummel CMonro-Kellie hypothesis: increase of ventricular CSF volume after surgical closure of a spinal dural leak in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2020;41(11):2055-2061."},{"issue":"1","key":"bib27","series-title":"Clin Neuroradiol","first-page":"231","article-title":"Brain spontaneous intracranial hypotension score for treatment monitoring after surgical closure of the underlying spinal dural leak","volume":"32","author":"Dobrocky","year":"2022","unstructured":"Dobrocky TH\u00e4ni LRohner RBrain spontaneous intracranial hypotension score for treatment monitoring after surgical closure of the underlying spinal dural leak. Clin Neuroradiol. 2022;32(1):231-238."},{"issue":"12","key":"bib28","series-title":"J Neurointerv Surg","first-page":"1256","article-title":"Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization","volume":"16","author":"Brinjikji","year":"2024","unstructured":"Brinjikji WMadhavan AGarza IClinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization. J Neurointerv Surg. 2024;16(12):1256-1263."},{"issue":"10","key":"bib29","series-title":"J Neurointerv Surg","first-page":"953","article-title":"Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization","volume":"14","author":"Brinjikji","year":"2022","unstructured":"Brinjikji WGarza IWhealy MClinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization. J Neurointerv Surg. 2022;14(10):953-956."},{"key":"bib30","series-title":"J Neurointerv Surg","first-page":"jnis-2024-022957","article-title":"Early brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension","author":"Cagnazzo","year":"2025","unstructured":"Cagnazzo FLe Bars ERisi GEarly brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension. J Neurointerv Surg. 2025:jnis-2024-022957."},{"key":"bib31","series-title":"Eur J Radiol Open","first-page":"100352","article-title":"Intravenous enhanced 3D FLAIR imaging to identify CSF leaks in spontaneous intracranial hypotension: comparison with MR myelography","volume":"8","author":"Osawa","year":"2021","unstructured":"Osawa IKozawa EMitsufuji TIntravenous enhanced 3D FLAIR imaging to identify CSF leaks in spontaneous intracranial hypotension: comparison with MR myelography. Eur J Radiol Open. 2021;8:100352."},{"issue":"5","key":"bib32","series-title":"AJNR Am J Neuroradiol","first-page":"906","article-title":"Relative decrease in signal intensity of subcortical white matter in spontaneous intracranial hypotension on fluid-attenuated inversion recovery images","volume":"30","author":"Adachi","year":"2009","unstructured":"Adachi MMugikura SShibata AKawaguchi ESato TTakahashi S.Relative decrease in signal intensity of subcortical white matter in spontaneous intracranial hypotension on fluid-attenuated inversion recovery images. AJNR Am J Neuroradiol. 2009;30(5):906-910."},{"issue":"2","key":"bib33","series-title":"Neurol Clin Pract","first-page":"93","article-title":"Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study","volume":"9","author":"Schievink","year":"2019","unstructured":"Schievink WIMaya MMJean-Pierre SMoser FGNu\u00f1o MPressman BD.Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study. Neurol Clin Pract. 2019;9(2):93-100."},{"issue":"7","key":"bib34","series-title":"Neuroradiology","first-page":"557","article-title":"Resolution of pachymeningeal enhancement following dural puncture and blood patch","volume":"37","author":"Gordon","year":"1995","unstructured":"Gordon REMoser FGPressman BDYoung W.Resolution of pachymeningeal enhancement following dural puncture and blood patch. Neuroradiology. 1995;37(7):557-558."},{"issue":"4","key":"bib35","series-title":"Chang Gung Med J","first-page":"293","article-title":"Spontaneous intracranial hypotension in a patient with reversible pachymeningeal enhancement and brain descent","volume":"26","author":"Tseng","year":"2003","unstructured":"Tseng YLChang YYLan MYWu HSLiu JS.Spontaneous intracranial hypotension in a patient with reversible pachymeningeal enhancement and brain descent. Chang Gung Med J. 2003;26(4):293-298."},{"issue":"23","key":"bib1","series-title":"N Engl J Med","first-page":"2173","article-title":"Spontaneous intracranial hypotension","volume":"385","author":"Schievink","year":"2021","unstructured":"Schievink WI.Spontaneous intracranial hypotension. N Engl J Med. 2021;385(23):2173-2178."},{"issue":"2","key":"bib2","series-title":"Pract Neurol","first-page":"98","article-title":"Spontaneous intracranial hypotension","volume":"24","author":"Cheema","year":"2024","unstructured":"Cheema SMehta DQureshi ASpontaneous intracranial hypotension. Pract Neurol. 2024;24(2):98-105."},{"issue":"1","key":"bib3","series-title":"BMJ Open","first-page":"e057438","article-title":"Patient experience of diagnosis and management of spontaneous intracranial hypotension: a cross-sectional online survey","volume":"12","author":"Cheema","year":"2022","unstructured":"Cheema SJoy CPople JSnape-Burns JTrevarthen TMatharu M.Patient experience of diagnosis and management of spontaneous intracranial hypotension: a cross-sectional online survey. BMJ Open. 2022;12(1):e057438."},{"issue":"4-5","key":"bib4","series-title":"Cephalalgia","first-page":"312","article-title":"Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020","volume":"42","author":"Schievink","year":"2022","unstructured":"Schievink WIMaya MMMoser FGSimon PNu\u00f1o M.Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020. Cephalalgia. 2022;42(4-5):312-316."},{"issue":"1","key":"bib5","series-title":"Cephalalgia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211."},{"issue":"5","key":"bib6","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."},{"key":"bib7","series-title":"Surg Neurol Int","first-page":"514","article-title":"Identification and surgical ligation of spinal CSF-venous fistula","volume":"12","author":"Majeed","year":"2021","unstructured":"Majeed KHanz SZRoytman MChazen JLGreenfield JP.Identification and surgical ligation of spinal CSF-venous fistula. Surg Neurol Int. 2021;12:514."},{"issue":"18","key":"bib8","series-title":"J Neurosurg Case Lessons","first-page":"CASE21730","article-title":"Minimally invasive surgery for spinal cerebrospinal fluid-venous fistula ligation: patient series","volume":"3","author":"Lohkamp","year":"2022","unstructured":"Lohkamp LNMarathe NNicholson PFarb RIMassicotte EM.Minimally invasive surgery for spinal cerebrospinal fluid-venous fistula ligation: patient series. J Neurosurg Case Lessons. 2022;3(18):CASE21730."},{"issue":"1","key":"bib9","series-title":"AJR Am J Roentgenol","first-page":"8","article-title":"Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension","volume":"206","author":"Kranz","year":"2016","unstructured":"Kranz PGLuetmer PHDiehn FEAmrhein TJTanpitukpongse TPGray L.Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;206(1):8-19."},{"issue":"27-28","key":"bib10","series-title":"Dtsch Arztebl Int","first-page":"480","article-title":"Spontaneous intracranial hypotension","volume":"117","author":"Urbach","year":"2020","unstructured":"Urbach HFung CDovi-Akue PL\u00fctzen NBeck J.Spontaneous intracranial hypotension. Dtsch Arztebl Int. 2020;117(27-28):480-487."},{"issue":"6","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1164","article-title":"Diffuse pachymeningeal hyperintensity and subdural effusion\/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension","volume":"29","author":"Tosaka","year":"2008","unstructured":"Tosaka MSato NFujimaki HDiffuse pachymeningeal hyperintensity and subdural effusion\/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2008;29(6):1164-1170."},{"issue":"8","key":"bib12","series-title":"Neurology","first-page":"1628","article-title":"Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI","volume":"42","author":"Hochman","year":"1992","unstructured":"Hochman MSNaidich TPKobetz SAFernandez-Maitin A.Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology. 1992;42(8):1628-1630."},{"issue":"4","key":"bib13","series-title":"Neurosurg Rev","first-page":"649","article-title":"Pachymeningeal enhancement-a comprehensive review of literature","volume":"38","author":"Antony","year":"2015","unstructured":"Antony JHacking CJeffree RL.Pachymeningeal enhancement-a comprehensive review of literature. Neurosurg Rev. 2015;38(4):649-659."},{"issue":"12","key":"bib14","series-title":"Neurology","first-page":"1746","article-title":"The Monro-Kellie hypothesis: applications in CSF volume depletion","volume":"56","author":"Mokri","year":"2001","unstructured":"Mokri B.The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology. 2001;56(12):1746-1748."},{"issue":"3","key":"bib15","series-title":"JAMA Neurol","first-page":"329","article-title":"Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis","volume":"78","author":"D\u2019Antona","year":"2021","unstructured":"D\u2019Antona LJaime Merchan MAVassiliou AClinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis. JAMA Neurol. 2021;78(3):329-337."},{"issue":"6","key":"bib16","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."},{"issue":"3","key":"bib17","series-title":"J Neurosurg","first-page":"475","article-title":"Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report","volume":"92","author":"Schievink","year":"2000","unstructured":"Schievink WITourje J.Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report. J Neurosurg. 2000;92(3):475-477."},{"issue":"6","key":"bib18","series-title":"AJR Am J Roentgenol","first-page":"1283","article-title":"Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension","volume":"207","author":"Kranz","year":"2016","unstructured":"Kranz PGAmrhein TJChoudhury KRTanpitukpongse TPGray L.Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;207(6):1283-1287."},{"issue":"3","key":"bib19","series-title":"Oper Neurosurg","first-page":"379","article-title":"Microsurgical repair of ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension: efficacy and safety of patch-sealing versus suturing","volume":"28","author":"Petutschnigg","year":"2024","unstructured":"Petutschnigg TH\u00e4ni LGoldberg JMicrosurgical repair of ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension: efficacy and safety of patch-sealing versus suturing. Oper Neurosurg. 2024;28(3):379-385."},{"issue":"3","key":"bib20","series-title":"Neurol Clin Pract","first-page":"e200290","article-title":"Diagnosis and treatment of spontaneous intracranial hypotension: role of epidural blood patching","volume":"14","author":"Callen","year":"2024","unstructured":"Callen ALFriedman DIParikh SDiagnosis and treatment of spontaneous intracranial hypotension: role of epidural blood patching. Neurol Clin Pract. 2024;14(3):e200290."},{"issue":"5","key":"bib21","series-title":"Neurol Clin Pract","first-page":"452","article-title":"Rapid onset and termination of neuroimaging findings in intracranial hypotension","volume":"3","author":"Rozen","year":"2013","unstructured":"Rozen TDSchievink WI.Rapid onset and termination of neuroimaging findings in intracranial hypotension. Neurol Clin Pract. 2013;3(5):452-453."},{"issue":"4","key":"bib22","series-title":"J Clin Epidemiol","first-page":"344","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","unstructured":"von Elm EAltman DGEgger MThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349."},{"issue":"7","key":"bib23","series-title":"AJNR Am J Neuroradiol","first-page":"1374","article-title":"Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure","volume":"37","author":"Kranz","year":"2016","unstructured":"Kranz PGTanpitukpongse TPChoudhury KRAmrhein TJGray L.Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure. AJNR Am J Neuroradiol. 2016;37(7):1374-1378."},{"issue":"5","key":"bib24","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."},{"issue":"3","key":"bib25","series-title":"Eur J Neurol","first-page":"947","article-title":"First-line steroid treatment for spontaneous intracranial hypotension","volume":"29","author":"Tonello","year":"2022","unstructured":"Tonello SGrossi UTrincia EZanus G.First-line steroid treatment for spontaneous intracranial hypotension. Eur J Neurol. 2022;29(3):947-949."},{"issue":"11","key":"bib26","series-title":"AJNR Am J Neuroradiol","first-page":"2055","article-title":"Monro-Kellie hypothesis: increase of ventricular CSF volume after surgical closure of a spinal dural leak in patients with spontaneous intracranial hypotension","volume":"41","author":"Dobrocky","year":"2020","unstructured":"Dobrocky TRebsamen MRummel CMonro-Kellie hypothesis: increase of ventricular CSF volume after surgical closure of a spinal dural leak in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2020;41(11):2055-2061."},{"issue":"1","key":"bib27","series-title":"Clin Neuroradiol","first-page":"231","article-title":"Brain spontaneous intracranial hypotension score for treatment monitoring after surgical closure of the underlying spinal dural leak","volume":"32","author":"Dobrocky","year":"2022","unstructured":"Dobrocky TH\u00e4ni LRohner RBrain spontaneous intracranial hypotension score for treatment monitoring after surgical closure of the underlying spinal dural leak. Clin Neuroradiol. 2022;32(1):231-238."},{"issue":"12","key":"bib28","series-title":"J Neurointerv Surg","first-page":"1256","article-title":"Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization","volume":"16","author":"Brinjikji","year":"2024","unstructured":"Brinjikji WMadhavan AGarza IClinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization. J Neurointerv Surg. 2024;16(12):1256-1263."},{"issue":"10","key":"bib29","series-title":"J Neurointerv Surg","first-page":"953","article-title":"Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization","volume":"14","author":"Brinjikji","year":"2022","unstructured":"Brinjikji WGarza IWhealy MClinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization. J Neurointerv Surg. 2022;14(10):953-956."},{"key":"bib30","series-title":"J Neurointerv Surg","first-page":"jnis-2024-022957","article-title":"Early brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension","author":"Cagnazzo","year":"2025","unstructured":"Cagnazzo FLe Bars ERisi GEarly brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension. J Neurointerv Surg. 2025:jnis-2024-022957."},{"key":"bib31","series-title":"Eur J Radiol Open","first-page":"100352","article-title":"Intravenous enhanced 3D FLAIR imaging to identify CSF leaks in spontaneous intracranial hypotension: comparison with MR myelography","volume":"8","author":"Osawa","year":"2021","unstructured":"Osawa IKozawa EMitsufuji TIntravenous enhanced 3D FLAIR imaging to identify CSF leaks in spontaneous intracranial hypotension: comparison with MR myelography. Eur J Radiol Open. 2021;8:100352."},{"issue":"5","key":"bib32","series-title":"AJNR Am J Neuroradiol","first-page":"906","article-title":"Relative decrease in signal intensity of subcortical white matter in spontaneous intracranial hypotension on fluid-attenuated inversion recovery images","volume":"30","author":"Adachi","year":"2009","unstructured":"Adachi MMugikura SShibata AKawaguchi ESato TTakahashi S.Relative decrease in signal intensity of subcortical white matter in spontaneous intracranial hypotension on fluid-attenuated inversion recovery images. AJNR Am J Neuroradiol. 2009;30(5):906-910."},{"issue":"2","key":"bib33","series-title":"Neurol Clin Pract","first-page":"93","article-title":"Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study","volume":"9","author":"Schievink","year":"2019","unstructured":"Schievink WIMaya MMJean-Pierre SMoser FGNu\u00f1o MPressman BD.Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study. Neurol Clin Pract. 2019;9(2):93-100."},{"issue":"7","key":"bib34","series-title":"Neuroradiology","first-page":"557","article-title":"Resolution of pachymeningeal enhancement following dural puncture and blood patch","volume":"37","author":"Gordon","year":"1995","unstructured":"Gordon REMoser FGPressman BDYoung W.Resolution of pachymeningeal enhancement following dural puncture and blood patch. Neuroradiology. 1995;37(7):557-558."},{"issue":"4","key":"bib35","series-title":"Chang Gung Med J","first-page":"293","article-title":"Spontaneous intracranial hypotension in a patient with reversible pachymeningeal enhancement and brain descent","volume":"26","author":"Tseng","year":"2003","unstructured":"Tseng YLChang YYLan MYWu HSLiu JS.Spontaneous intracranial hypotension in a patient with reversible pachymeningeal enhancement and brain descent. Chang Gung Med J. 2003;26(4):293-298."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/7\/article-CASE25819.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/7\/article-CASE25819.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/7\/article-CASE25819.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:26:11Z","timestamp":1776093971000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/7\/article-CASE25819.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":70,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case25819","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]}}}