TY - JOUR T1 - Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 2055 LP - 2061 DO - 10.3174/ajnr.A6782 VL - 41 IS - 11 AU - T. Dobrocky AU - M. Rebsamen AU - C. Rummel AU - L. Häni AU - P. Mordasini AU - A. Raabe AU - C.T. Ulrich AU - J. Gralla AU - E.I. Piechowiak AU - J. Beck Y1 - 2020/11/01 UR - http://www.ajnr.org/content/41/11/2055.abstract N2 - BACKGROUND AND PURPOSE: CSF loss in spontaneous intracranial hypotension disrupts a well-regulated equilibrium. We aimed to evaluate the volume shift between intracranial compartments in patients with spontaneous intracranial hypotension before and after surgical closure of the underlying spinal dural breach.MATERIALS AND METHODS: In total, 19 patients with spontaneous intracranial hypotension with a proved spinal CSF leak investigated at our institution between July 2014 and March 2017 (mean age, 41.8 years; 13 women) were included. Brain MR imaging–based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated.RESULTS: Total mean ventricular CSF volume significantly increased from baseline (15.3 mL) to posttreatment MR imaging (18.0 mL), resulting in a mean absolute and relative difference, +2.7 mL and +18.8% (95% CI, +1.2 to +3.9 mL; P < .001). The change was apparent in the early follow-up (mean, 4 days). No significant change in mean total brain volume was observed (1136.9 versus 1133.1 mL, P = .58). The mean spontaneous intracranial hypotension score decreased from 6.9  ± 1.5 at baseline to 2.9 ± 1.5 postoperatively.CONCLUSIONS: Our study demonstrated a substantial increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.CSFVFCSF venous fistulaMDEFTmodified driven equilibrium Fourier transformSIHspontaneous intracranial hypotension ER -