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Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI

A Preliminary Study

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Abstract

Objective/Background

We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions.

Methods

Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range.

Results

The cohort consisted of 10 males (63%) and 6 females with a mean age of 54 years (range 37–72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88%) had a BMI below the matched national average, while only two patients (13%) had values above the national average (p = 0.004).

Conclusions

Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.

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Acknowledgements

The authors thank Sonia Watson, PhD, and Andrea Moran for assistance in editing the manuscript.

Funding

There was no external funding source for this study.

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Authors

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Correspondence to Felix E. Diehn.

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Conflict of interest

R.E. Rosebrock, F.E. Diehn, P.H. Luetmer, J.T. Wald, J.I. Lane, J.M. Morris, V.T. Lehman, C.M. Carr, B. Mokri and K.R. Thielen declare that they have no competing interests.

Ethical standards

This study obtained approval from the Mayo Clinic Institutional Review Board, approval number 11-007806 and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Rosebrock, R.E., Diehn, F.E., Luetmer, P.H. et al. Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI. Clin Neuroradiol 28, 539–543 (2018). https://doi.org/10.1007/s00062-017-0596-6

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  • DOI: https://doi.org/10.1007/s00062-017-0596-6

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