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Paul M. Lin and Joseph Clarke

that within the epidural vein is at times lower depending on the phases of respiratory movement and prone or supine position of the patient. 1 With the patient prone, the rapid flow of blood 2 within the epidural vein might also produce a suction effect (Venturi's law) that would further enhance passage of fluid from an area of higher pressure (subarachnoid space) to one where the pressure was lower (epidural veins). The realization that there is a mechanism for flow of Pantopaque into venous channels through a cerebrospinal fluid-venous fistula seriously

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Wouter I. Schievink, M. Marcel Maya and Franklin G. Moser

A spinal CSF–venous fistula is one of three specific types of spinal CSF leak that can be seen in patients with spontaneous intracranial hypotension (SIH). They are best demonstrated on specialized imaging, such as digital subtraction myelography (DSM) or dynamic myelography, but often they are diagnosed on the basis of increased contrast density in the draining veins (the so-called hyperdense paraspinal vein sign) on early postmyelography CT scans. The authors report on 2 patients who underwent directed treatment (surgery in one patient and glue injection in the other) based on the hyperdense paraspinal vein sign, in whom the actual site of the fistula did not correspond to the level or laterality of the hyperdense paraspinal vein sign. The authors suggest consideration of DSM or dynamic myelography prior to undertaking treatment directed at these fistulas.

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Wouter I. Schievink, M. Marcel Maya and Franklin G. Moser

A spinal CSF–venous fistula is one of three specific types of spinal CSF leak that can be seen in patients with spontaneous intracranial hypotension (SIH). They are best demonstrated on specialized imaging, such as digital subtraction myelography (DSM) or dynamic myelography, but often they are diagnosed on the basis of increased contrast density in the draining veins (the so-called hyperdense paraspinal vein sign) on early postmyelography CT scans. The authors report on 2 patients who underwent directed treatment (surgery in one patient and glue injection in the other) based on the hyperdense paraspinal vein sign, in whom the actual site of the fistula did not correspond to the level or laterality of the hyperdense paraspinal vein sign. The authors suggest consideration of DSM or dynamic myelography prior to undertaking treatment directed at these fistulas.