Imaging of CSF-Venous Fistulas at the High and Low Ends of the Spine: Techniques and Case Examples

CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Most CSF-venous fistulas occur in the thoracic spine, and recently described myelographic techniques have been primarily tailored to localize fistulas in this location.^{1 -4} However, a small subset of CSF-venous fistulas can occur at the superior or inferior ends of the spine, ranging from the skull base to the sacrum. In this Video Article, we discuss modifications to decubitus myelography needed to safely and confidently diagnose CSF-venous fistulas at the extremes of the spine, including the skull base and sacrum.^{5 -7} We also show unique case examples of these relatively uncommon leaks, which were found using decubitus digital subtraction or CT myelography with simple technical modifications.