Morphological study and dynamic flow analysis of the mechanism of normal or abnormal leakage phenomena in the collateral pathway of cerebrospinal fluid absorption via the epidural lymphatic system.

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Imaging a leak phenomenon from the contralateral lumbosacral nerve root using radioisotope (RI) cisternography has recently been considered an important effective criterion in the differential diagnosis of cerebrospinal fluid (CSF) hypovolemia. In this study, we looked for clues to help us understand the phenomenon of physiological CSF absorption; we used an ICG fluorescence imaging system on the lumbosacral spinal region, where frequent CSF leakage has been observed using RI cisternography.Our findings indicate that images such as the Christmas tree sign seen in the areas of multi-segmental nerve roots, which have been considered as abnormal CSF leak images on RI cisternography, may actually be normal (physiological) images without any abnormal leak or escape of CSF at the site of transition between the spinal dura mater and nerve roots.