Spinal CSF Leak Foundation

At BTG 2025, we played a video of our global patient community sharing their lived experience with spinal CSF leak. The video is now available: youtu.be/L6AgcN29LHc Thank you to all who contributed! We hope this video helps open supportive conversations.

@TheAJNR My 🔥hot take: If you aren’t seeing rebound intracranial hypertension after TVE, it’s because you either aren’t embolizing fistulas or you aren’t asking about it

Check our Editor’s choice for the month: ‘’ Incidence and Predictors of Rebound Intracranial Hypertension after Transvenous Embolization of CSF-Venous Fistulas’’ In this single-center retrospective study, the incidence and severity of rebound intracranial hypertension after transvenous embolization for CSF-venous fistulas causing SIH appeared to be 80%, with 54% of patients experiencing moderate-to-severe symptoms and 7.6% requiring therapeutic lumbar puncture. Treatment of a single fistula and higher preprocedural opening pressures were associated with an increased risk of more severe RIH and need for intervention. ajnr.org/content/47/5/1…

“Classic” textbook orthostatic headache was actually more common in the myelography-negative group than in patients with confirmed CVF. The most common CVF phenotype was instead “partial orthostatic” headache: posture clearly matters, but not in the clean binary way we traditionally describe. This does NOT mean orthostatic headache is unimportant. It does suggest we may need a more nuanced understanding of what a “good story for a leak” actually looks like in low-Bern patients.

New @TheAJNR #CSFLeak paper out today: ajnr.org/content/early/… We focused specifically on low-Bern patients, the diagnostically ambiguous group where clinical history often drives the decision to pursue myelography for suspected CVF. One of the most interesting findings was… ↓

@The_ASSR @NeuroradLal @ZanderCharlotte @PeterGKranz @vinil_shah @AmishDoshiMD @TimAmrheinMD @AjayMadhavanMD @JMcCartyMD @LeviChazen @WendeNGibbs Congratulations @ZanderCharlotte!

The 2026 ASSR Bassem A. Georgy Award (Interventional Spine Radiology) winner is Charlotte Zander!! 🥳 Congratulations!! @The_ASSR #Spine #Radiology theassr.org

Some patients continue with CSF leak symptoms although there is no longer any evidence of a leak on imaging. Surgical exploration and dural repair can result in symptom resolution for a highly selected group of patients @spinalCSFleak @issclsociety pubmed.ncbi.nlm.nih.gov/41927342/

An exciting milestone for the ileak registry℠, our international patient registry designed to help advance research & improve understanding of spinal CSF leak: materials have been formally submitted for processing with the Institutional Review Board (IRB). More details soon!

“This report describes the CT fluoroscopy–guided circumferential EBP, a technique that achieves 360° coverage of patching material around the thecal sac using combined ventral transforaminal and dorsal interlaminar injections” ajnr.org/content/47/4/1… From the @DukeRadiology team:

Open Access: 🧠“Normal” imaging or opening pressure doesn’t rule out #CSF disorders. 📑A new review reframes #SIH & #IIH as a continuum—not separate conditions. 🔍 Think mechanism, not labels 🔗…adachejournal.onlinelibrary.wiley.com/share/RYGNPPUJ… @AndrewCallenMD #Headache #Neuroimaging

“Together, these insights reinforce the notion that in SIH, imaging must be interpreted as a window into a patient's physiology in the context of their symptoms, rather than a direct marker of the presence or absence of a spinal CSF leak, or a proxy for symptom burden.”

Pediatric headache often falls outside of the purview of headache specialists. Congratulations to ⁦⁦⁦@NeurosciencesCS⁩ CSFleak fellow #DrCatGarcia on her study showing DSM to be safe and accurate in localizing leaks in children @spinalCSFleak pubmed.ncbi.nlm.nih.gov/41927334/

We see more and more lateral dural tear #CSFleaks with small epidural fluid missed because the correct MRI sequences were not obtained. 3DT2FS really shines in this context. Sometimes the 🔑 isn't new technology, but re-understanding how to look at existing data.

apply to this one of a kind fellowship!! @spinalCSFleak

Spinal CSF-venous fistulas almost always arise from meningeal diverticula. The diverticular size can vary from tiny (submillimeter) to massive (think dural ectasia). At least one-third of diverticula change size when a fistula forms ⁦@spinalCSFleak⁩ pubmed.ncbi.nlm.nih.gov/41730631/

One of the most interesting observations from the study. In this patient, an acute sacral dural tear evolved after patching into cystic structures that could easily be interpreted as “Tarlov cysts.” Surgery later confirmed a persistent leak with arachnoid herniation. Not all Tarlov cysts are pathologic — but some may represent the chronic end of a dural tear spectrum. (Figure from the paper 👇)

Sacral dural tears in #SIH are probably under-recognized. Why? Because the sacrum often isn’t scrutinized, or sometimes even included in the field of view on routine spine imaging. In a new multicenter @AJNR study we found: • Sacral leaks often produce isolated sacral CSF collections • Image-guided patching can lead to meaningful clinical & imaging improvement • Longitudinal imaging suggests some lesions mimicking “Tarlov cysts” may actually represent chronic or partially healed leaks Encouraging to see multicenter collaboration continue to emerge in SIH imaging/treatment research. ajnr.org/content/early/…

"Improved Conspicuity of CSF-Venous Fistulas with Saline Pressure Augmentation: A Multi-Institutional Case Series" @AjayMadhavanMD doi.org/10.3174/ajnr.A…

Save the date! Inaugural meeting of the International Society for Spinal CSF leak in New York City, New York, October 17&18, 2026. ⁦@spinalCSFleak⁩ ⁦@csfleakuk⁩ ⁦@SpinalCSFLeakAu⁩ ⁦@SpinalCSFCanada⁩ ⁦@issclsociety⁩ ⁦@PeterGKranz⁩

One of the most common excuses for not using atraumatic needles for LPs: “They cost more” New study shows the opposite is true when you look downstream: • 19 fewer PDPH per 100 LPs • Fewer hospitalizations & blood patches • Net cost savings The cheapest needle is the one that doesn’t cause a leak. link.springer.com/article/10.118…

"The greatest prevalence rates by level were in the lower thoracic spine at T7, T9, & T10. One possible etiology for this pattern could be the azygous vein & an abundance of arachnoid granulations at these levels."