PD Dr. med. Eike Immo Piechowiak is a specialist in radiology with a focus on diagnostic and invasive neuroradiology and has been head physician at the University Institute for Diagnostic and Interventional Neuroradiology at Inselpital in Bern since 2020. 
After studying medicine at the University of Freiburg, Germany, Eike Piechowiak completed his residency in radiology at the University Hospital Marburg, Germany, and at the Institute of Radiology at the Inselspital Bern. There he subsequently specialized in diagnostic and especially interventional neuroradiology under the direction of Prof. Jan Gralla.
His main research interests are imaging and interventional therapy of spinal CSF leaks as well as minimally invasive treatment and diagnostics of ischemic stroke.
Most significant achievement: Three wonderful children who keep me fit.

 Is it leaking or am I freakin’: Flat-Panel for the detection of CSF-venous fistulas

Spontaneous Intracranial Hypotension (SIH) due to a spinal cerebrospinal fluid (CSF) leak is an increasingly recognized condition associated with clinically debilitating headaches and a significant impact on quality of life. 
Spinal CSF leaks are categorized into three major types: Type I leaks consist of ventral dural tears, most commonly caused by discogenic microspurs. Type II leaks result from ruptures of dural nerve root sleeves, typically occurring along the inferior side of the sleeve. Type III leaks involve direct connections between the intrathecal compartment and epidural or intraforaminal veins, referred to as CSF-venous fistulas (CSFVF). 
The cerebrospinal fluid venous fistula (CSFVF) was first described in 2014 and remains challenging to localize. This difficulty arises from the typically low flow into the fistula in conventional myelographic studies and the complexity of imaging acquisition timing. The optimal imaging technique for detecting these fistulas remains a topic of ongoing debate.
Currently, three primary modalities are employed for their identification: digital subtraction myelography (DSM), computed tomography myelography (CT myelography), and flat-panel CT myelography (FP-CT myelography). With advancements in angiography systems, FP-CT myelography provides high spatial resolution and can be seamlessly integrated into routine dynamic myelographic protocols. The combined use of digital subtraction myelography and FP-CT within the same examination offers complementary advantages: DSM enables high temporal resolution, while FP-CT provides superior spatial resolution. This combined approach has the potential to significantly improve the detection rate of CSFVFs.