Idiopathic Intracranial Hypotension and Cerebrospinal Fluid Leaks: Advances in Imaging and Procedural Management

Abstract Idiopathic intracranial hypotension (IIH) and cerebrospinal fluid (CSF) leaks are increasingly recognized causes of debilitating headaches and neurological dysfunction. Accurate diagnosis and timely management are essential to prevent long-term disability. This review aims to synthesize the current knowledge surrounding the pathophysiology of IIH and CSF leaks, with a particular focus on diagnostic imaging strategies and emerging treatment approaches. A comprehensive review of recent literature was performed, focusing on the pathophysiology, imaging modalities, and treatment strategies for IIH and spontaneous CSF leaks. Emphasis was placed on the role of dynamic myelography, digital subtraction myelography, high-resolution CT myelography, MRI, and interventional radiology techniques in the diagnosis and management of these conditions. Recent advances in neuroimaging, particularly digital subtraction myelography and high-resolution CT, have significantly improved the detection and localization of CSF leaks. Classification systems based on imaging findings guide the selection of treatment strategies, ranging from conservative management and epidural blood patches to minimally invasive embolization and surgical repair. Endovascular embolization for CSF-venous fistulas has demonstrated high rates of symptom resolution and radiological improvement, albeit with a risk of rebound intracranial hypertension. With improved imaging techniques and growing awareness, IIH and CSF leaks can now be accurately diagnosed and effectively managed. A structured, imaging-centered diagnostic algorithm is essential for directing individualized therapy and optimizing clinical outcomes.