Role of Conventional Dynamic Myelography for Detection of High-Flow Cerebrospinal Fluid Leaks : Optimizing the Technique.

Piechowiak, Eike I.; Pospieszny, Katarzyna; Haeni, Levin; Jesse, Christopher M.; Peschi, Giovanni; Mosimann, Pascal J.; Kaesmacher, Johannes; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian T.; Beck, Jürgen; Gralla, Jan; Dobrocky, Tomas (2020). Role of Conventional Dynamic Myelography for Detection of High-Flow Cerebrospinal Fluid Leaks : Optimizing the Technique. (In Press). Clinical neuroradiology Springer-Verlag 10.1007/s00062-020-00943-w

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BACKGROUND

Spinal imaging is essential to identify and localize cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension (SIH) patients when targeted treatment is necessary.

PURPOSE

Provide an in-depth presentation of the conventional dynamic myelography (CDM) technique for localizing spinal CSF leaks in SIH patients.

MATERIAL AND METHODS

Consecutive SIH patients with a CSF leak confirmed on CDM and postmyelography computed tomography (CT) investigated at our institution between 2013 and 2019 were retrospectively analyzed. Intraoperative reports were reviewed to confirm the accuracy of CDM.

RESULTS

In total, 62 patients (mean age 45 years) were included; 48 with a ventral dural tear, 12 with a meningeal diverticulum, and in 2 patients positive for spinal longitudinal extradural CSF collection the site remained unclear. The leak was identified during the first and the second CDM in 43 and 17 patients, respectively. The use of CDM correctly identified the site of the CSF leak in all but one patient undergoing surgical closure (45/46, 98%). The mean fluoroscopy time was 7.8 min (range 1.8-14.4 min) with a radiation dose for a single examination of 310 mGy (range 28-1237 mGy).

CONCLUSION

The CDM procedure has a high accuracy for spinal CSF leak localization including dural tears and spinal nerve diverticula. It is the technique with the highest temporal resolution, is robust to breathing artifacts, allows great flexibility regarding patient positioning, compares favorably to other dynamic examinations with respect to the radiation dose and does not require general anesthesia. For CSF venous fistulas, however, other dynamic examinations, such as digital subtraction myelography, seem more appropriate.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Piechowiak, Eike Immo; Pospieszny, Katarzyna Maria; Häni, Levin; Jesse, Christopher Marvin; Peschi, Giovanni; Mosimann, Pascal John; Kaesmacher, Johannes; Mordasini, Pasquale; Raabe, Andreas; Ulrich, Christian Thomas; Beck, Jürgen; Gralla, Jan and Dobrocky, Tomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1447

Publisher:

Springer-Verlag

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

02 Sep 2020 16:05

Last Modified:

10 Mar 2021 06:54

Publisher DOI:

10.1007/s00062-020-00943-w

PubMed ID:

32845353

Uncontrolled Keywords:

CSF leak Conventional dynamic myelography Spontaneous intracranial hypotension

BORIS DOI:

10.7892/boris.146202

URI:

https://boris.unibe.ch/id/eprint/146202

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