{
  "abstract": "Objective The relationship between cerebrospinal fluid (CSF)-venous fistulas (CVFs) and meningeal diverticula (MD) remain insufficiently characterized. This study aimed to characterize MD in confirmed CVF patients, including those at the fistula site and overall burden, to define their imaging features, distribution, and value for CVF localization.Methods In this retrospective two-center study (January 2021–June 2025), consecutive patients with confirmed CVFs were included. Screening of MD was performed on coronal heavily T2-weighted MRI. Leak-level evaluation used CT-/cone beam CT (CBCT)-myelography to assess presence, size, and morphology. The main readers were not blinded to CVF location.Results Among 173 patients (99 women) with 200 CVFs, mean age was 61.7±13.9 years, mean body mass index was 24.9±4.3 kg/m 2, and median Bern score was 6 (IQR 4–8).Patients aged ≥50 years were more prevalent (82%), showed more (9.2±7.6 vs 3.4±4.1, p<0.001) and larger MD (4–15 mm, p<0.001), and higher prevalence of subdural hematomas (40% vs 13%, p<0.05) than those aged <50 years.Patients without MD on MRI (13%) were younger (52.6±15.9 vs 63.0±13.1 years, p<0.001), rarely had multiple (1/23) and no bilateral CVFs. At leak level, MD were the origin of CVF in 80% (159/200), were more frequent and larger in patients aged>50 years (84% vs 54%, p<0.001; 7.2±3.6 vs 5.2±1.8 mm, p<0.001), and predominantly round-ovoid (70%).CVFs mainly arose between T6 and T12 (81%), corresponding to 73% of the largest MD location. CVFs originated in 19% at and in 53% within ±2 bilateral levels around the largest MD, and were right-sided in 66% when the largest MD was right-sided.Conclusions MD were strongly associated with CVFs and were more frequent and larger in older patients. On MRI, MD had limited value for CVF localization, whereas the lower thoracic spine was a more reliable predictor.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Niklas Lützen"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Horst Urbach"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Charlotte Zander"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Alexander Rau"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Florian Volz"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Amir El Rahal"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Katharina Wolf"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Laura Krismer"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany"
      ],
      "name": "Jürgen Beck"
    },
    {
      "affiliations": [
        "Section of Statistics, Pisa University Hospital, Pisa, Italy"
      ],
      "name": "Riccardo Morganti"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac, Montpellier, France"
      ],
      "name": "Vincent Costalat"
    },
    {
      "affiliations": [
        "Department of Neurology, Montpellier University Hospital, Gui de Chauliac, Montpellier, France"
      ],
      "name": "Anne Ducros"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montpellier University Hospital, Gui de Chauliac, Montpellier, France"
      ],
      "name": "Nicolas Lonjon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac, Montpellier, France",
        "Department of Radiology-Neuroradiology, Ospedale SS Annunziata di Taranto, Taranto, Italy"
      ],
      "name": "Antonio Marrazzo"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac, Montpellier, France"
      ],
      "name": "Federico Cagnazzo"
    }
  ],
  "title": "Characterization of meningeal diverticula in patients with cerebrospinal fluid-venous fistulas",
  "uid": "25237f00-49dd-5c56-b79f-af15720c51de"
}