The Association of Spinal Meningeal Diverticula Number and Size with the Detection of CSF-Venous Fistulas: Evidence from a Contemporary Myelography Cohort
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT BACKGROUND AND PURPOSE: Meningeal diverticula are commonly seen on spine imaging, but their relationship to cerebrospinal fluid (CSF) leak remains debated. A prior study found no association with spontaneous intracranial hypotension (SIH), but this predated recognition of CSF venous fistulas (CVF). We re-examined this question, hypothesizing that greater diverticula burden is associated with a higher rate of CVF on myelography. Secondary aims included exploring associations with age, sex, and connective tissue disease (CTD). MATERIALS AND METHODS: Spine MRIs of 42 consecutive patients who underwent dynamic myelography for suspected CVF (April 2024–January 2025) were reviewed; those without 3D T2 fat-suppressed MRI were excluded. Diverticular size and number were quantified, and CVF presence on myelography was recorded. Associations were examined using parametric and non-parametric tests, trend analyses, and age-and sex-adjusted logistic regression models. RESULTS: Patients with definite CVF had significantly larger (mean 8.2 vs 4.7 mm, p=0.009) and more diverticula (median 21 vs 9, p=0.03). Nonparametric trend testing further confirmed stepwise increases in both diverticular number (Spearman’s ρ=0.44, p=0.005) and size (ρ=0.37, p=0.02). Patients with definite CVF were significantly older than controls (mean 62.6 vs 48.3 years, p=0.001). Adjusted analyses including age and sex showed borderline associations with diverticular size (OR 1.20, 95% CI 1.00–1.43, p=0.05) and number (OR 1.06, 95% CI 0.99–1.13, p=0.09); age remained an independent predictor in both models. No associations were observed with sex or CTD. CONCLUSIONS: Both the number and size of diverticula were associated with the presence of CVF, challenging assumptions that diverticula are incidental in SIH and suggesting that diverticular burden may offer supportive information when evaluating patients for suspected CVF, while recognizing that age exerts a strong influence on both diverticular burden and CVF status. ABBREVIATIONS: CSF＝ Cerebrospinal Fluid; CVF＝ CSF venous fistula; SIH = Spontaneous Intracranial Hypotension; CTD = Connective Tissue Disease
DOI: 10.3174/ajnr.a9138
Authors: Cara Campbell, Daniel Montes, Debayan Bhaumik, Peter Lennarson, Andrew L. Callen
Institution: University of Colorado Anschutz
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4417280342