Fluids and barriers of the CNS
Brain distortion and cerebrospinal fluid shifts in spontaneous intracranial hypotension
By El Rahal A, Beck J, Wolf K and 6 others.
Abstract
Background
Spinal cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension (SIH) are assumed to cause intracranial CSF volume changes and brain sagging. The spatial pattern of CSF and brain volume changes, or shifts, remains incompletely characterized. We aimed to quantify CSF and brain shifts before and after surgical closure of spinal CSF leaks.
Methods
We retrospectively analyzed 96 patients with SIH before and after surgical closure of their spinal CSF leaks. Artificial intelligence (AI)-assisted automated diffeomorphic registration and brain region segmentation of pre- and postoperative MRI imaging were used to extract a perioperative displacement map of the brain and the mean 3D displacement vector for each anatomical region. Regions were tested for significant changes using Hotelling's T2 and compared against a healthy control cohort (n = 61) processed identically.
