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Research ArticleSpine Imaging and Spine Image-Guided Interventions

Optic Nerve Sheath MR Imaging Measurements in Patients with Orthostatic Headaches and Normal Findings on Conventional Imaging Predict the Presence of an Underlying CSF-Venous Fistula

Wouter I. Schievink, Marcel M. Maya, Angelique Sao-Mai S. Tay, Peyton L. Nisson, Jay Acharya, Rachelle B. Taché and Miriam Nuño
American Journal of Neuroradiology May 2024, 45 (5) 655-661; DOI: https://doi.org/10.3174/ajnr.A8165
Wouter I. Schievink
aFrom the Departments of Neurosurgery (W.I.S., A.S.-M.S.T., P.L.N., R.B.T.), Cedars-Sinai Medical Center, Los Angeles, California
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  • ORCID record for Wouter I. Schievink
Marcel M. Maya
bDepartments of Imaging (M.M.M., J.A.), Cedars-Sinai Medical Center, Los Angeles, California
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  • ORCID record for Marcel M. Maya
Angelique Sao-Mai S. Tay
aFrom the Departments of Neurosurgery (W.I.S., A.S.-M.S.T., P.L.N., R.B.T.), Cedars-Sinai Medical Center, Los Angeles, California
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Peyton L. Nisson
aFrom the Departments of Neurosurgery (W.I.S., A.S.-M.S.T., P.L.N., R.B.T.), Cedars-Sinai Medical Center, Los Angeles, California
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Jay Acharya
bDepartments of Imaging (M.M.M., J.A.), Cedars-Sinai Medical Center, Los Angeles, California
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Rachelle B. Taché
aFrom the Departments of Neurosurgery (W.I.S., A.S.-M.S.T., P.L.N., R.B.T.), Cedars-Sinai Medical Center, Los Angeles, California
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Miriam Nuño
cDepartment of Public Health Sciences (M.N.), University of California, Davis, Davis, California
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Figures

  • FIG 1.
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    FIG 1.

    How to measure the ONSD and perioptic subarachnoid space. Illustration (A) depicting the measurements for the ONSD and the perioptic subarachnoid space. Pre- (B) and post- (C) operative coronal fat-suppressed T2-weighted MR imaging shows restoration of the perioptic subarachnoid space (arrows) following ligation of a spinal CSF-venous fistula.

  • FIG 2.
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    FIG 2.

    ONSD and perioptic subarachnoid space measurements in patients with and without spinal CSF-venous fistulas. Box and whisker plots of the ONSD and perioptic SAS in patients without and with a spinal CSF-venous fistula. The box represents the upper and lower quartiles with the line splitting the box representing the median. The diamond represents the mean. The whiskers represent the upper and lower values of the data, up to 1.5 times the interquartile range. The single points represent the outliers.

  • FIG 3.
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    FIG 3.

    Predicted probability of finding a spinal CSF-venous fistula based on the ONSD and perioptic subarachnoid space measurements. The graphs depict the predicted probability (and 80% confidence intervals) of identifying a CSF-venous fistula according to ONSD and perioptic SAS.

  • FIG 4.
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    FIG 4.

    The relationship among the BMI, CSF opening pressure, ONSD, and perioptic subarachnoid space. Scatterplots depict the relationships among BMI, CSF OP (in centimeters CSF), ONSD, and the perioptic SAS. By ranking from the weakest to the strongest correlation, positive correlations are found between the ONSD and OP, BMI and OP, perioptic SAS and OP, and ONSD and perioptic SAS.

  • FIG 5.
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    FIG 5.

    Normalization of the ONSD and perioptic subarachnoid space following ligation of spinal CSF-venous fistulas. Individual measurements of the pre- and postoperative ONSD and perioptic SAS following ligation of the spinal CSF-venous fistula.

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American Journal of Neuroradiology: 45 (5)
American Journal of Neuroradiology
Vol. 45, Issue 5
1 May 2024
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Cite this article
Wouter I. Schievink, Marcel M. Maya, Angelique Sao-Mai S. Tay, Peyton L. Nisson, Jay Acharya, Rachelle B. Taché, Miriam Nuño
Optic Nerve Sheath MR Imaging Measurements in Patients with Orthostatic Headaches and Normal Findings on Conventional Imaging Predict the Presence of an Underlying CSF-Venous Fistula
American Journal of Neuroradiology May 2024, 45 (5) 655-661; DOI: 10.3174/ajnr.A8165

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Optic Nerve Sheath MRI for CSF-Venous Fistula
Wouter I. Schievink, Marcel M. Maya, Angelique Sao-Mai S. Tay, Peyton L. Nisson, Jay Acharya, Rachelle B. Taché, Miriam Nuño
American Journal of Neuroradiology May 2024, 45 (5) 655-661; DOI: 10.3174/ajnr.A8165
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