Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with spontaneous intracranial hypotension

Fujimaki, Hiroya; Saito, Nobuhito; Tosaka, Masahiko; Tanaka, Yoshiaki; Horiguchi, Keishi; Sasaki, Tomio

doi:10.1016/s0090-3019(02)00801-7

Cited by 28 publications

(20 citation statements)

References 9 publications

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“…16 The current case further emphasizes that identification of the precise location of the CSF leak is crucial for providing effective treatment. 17 High resolution CT myelography was previously shown to definitively demonstrate the durotomy site after lumbar surgery, 18 and this technique was also used to establish the diagnosis of a dural tear and to identify the location of the CSF leak in our patient. Interestingly, a pseudomeningocele was later identified during the subsequent lumbar-sacral MRI study after our patient's symptoms recurred, suggesting that sufficient time had elapsed to allow a contained CSF accumulation outside the subarachnoid space.…”

Section: Discussionmentioning

confidence: 86%

Case report: Delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy

Kundu

Sano

Pagel

2008

Can J Anesth/J Can Anesth

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Purpose: To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy. Clinical features:A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontalretroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment. Conclusion:This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.

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Section: Discussionmentioning

confidence: 86%

Case report: Delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy

Kundu

Sano

Pagel

2008

Can J Anesth/J Can Anesth

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“…Отсутствуют исследования, касающиеся изучения отдаленных результатов лечения дураль-ных ликворных фистул [3].…”

Section: сïîíòàííàя ñïèíàëьíàя äóðàëьíàя ëèêвîðíàя ôèñòóëàunclassified

“…Требуется точная идентификация места фистулы. Çачастую не удается перевязать твер-дую оболочку спинного мозга в месте истечения СМЖ, необходимо накладывать на нее швы, заклеивать мес-то, где наложены швы, или осуществлять пластику твердой оболочки спинного мозга [2,3,6,8].…”

Section: ðèñ 2 интраоперационное фотоunclassified

Spontaneous spinal liquor fistula: case report

Слынько¹,

Золотоверх²

2011

Ukr Neurosurg J

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Сïîíòàííàя ñïèíàëьíàя äóðàëьíàя ëèêвîðíàя ôèñòóëàИнститут нейрохирургии им. акад. А.П. Ромоданова НАМН Украины, г. Киев Ввåäåíèå. Дуральные ликворные фистулы пред-ставляют собой редкую патологию, характеризующуюся нарушением целостности твердой и подпаутинной обо-лочек спинного мозга с просачиванием спинномозговой жидкости (СМЖ) за пределы твердой оболочки [1]. Это обусловливает длительное снижение давления СМЖ и появление неврологических симптомов. Диагностика таких фистул крайне сложна, требует специального подхода, но самое главное -клинического предполо-жения о наличии дуральной фистулы [2].Эта патология описана совсем недавно, не опреде-лены ни алгоритм ее диагностики, ни хирургическая тактика. Отсутствуют исследования, касающиеся изучения отдаленных результатов лечения дураль-ных ликворных фистул [3].Приводим собственное наблюдение спинальной дуральной ликворной фистулы, а также анализ данных литературы.Больная 36 лет, жаловалась на головную боль, общую слабость, умеренную слабость нижних конеч-ностей, боль в груди. Эти симптомы возникли почти 12 лет, с несущественными ремиссиями. Консерва-тивное лечение неэффективно.По данным МРТ головы, шейного, грудного, по-ясничного отделов позвоночника выраженные нару-шения не обнаружены. При функциональной рентге-нографии всех отделов позвоночника нестабильность не выявлена. Возникло клиническое предположение о хронической ликворной гипотензии и возможности образования дуральной ликворной фистулы.В связи с этим больной проведена люмбальная пункция, введено 10 мл омнипака и через 40 мин -компьютерная томография (КТ) головы, шейного, грудного и поясничного отделов позвоночника.На уровне T XI слева выявлена дуральная лик-ворная фистула (ðèñ. 1).

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“…2 Precise determination of the spinal level of the leak is important in the diagnosis and treatment of SIH. Several different imaging modalities may be used to assist in making the diagnosis, such as spinal magnetic resonance imaging (MRI) 3 isotope cisternogram, 4 computed tomography (CT) with contrast, 4 CT myelography, 5 and MRI myelography. 6,7 Epidural blood patch (EBP) is the treatment of choice for persistent postural headache.…”

Section: Regional Anesthesia and Painmentioning

confidence: 99%

Regional Anesthesia and Pain Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test)

Morley‐Forster

Abotaiban

Ganapathy

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: This case report describes the use of electrical epidural stimulation (Tsui test) to confirm accurate placement of a thoracic epidural catheter when administering an epidural blood patch for headache management in a patient suffering from spontaneous intracranial hypotension. Clinical features:A 41-yr-old female presented to the Chronic Pain Clinic with a history of postural headache symptoms worsening in severity over several years. Two previous blood patches performed at T11-12 and T10-11 respectively provided short-term relief only. The presumed diagnosis of a spontaneous dural tear was confirmed by a nuclear flow test to be at T2-T4. The epidural site was accessed at T6 with a Tuohy needle. To accurately place the epidural blood patch at the level of the dural tear, the Arrow catheter with electrode adapter was advanced under nerve stimulation guidance to T4. Ten millilitres of autologous blood injected through the catheter was confirmed on magnetic resonance imaging, one hour postprocedure, to lie between T3 and T9. Sustained headache relief was achieved. Conclusion:The use of electrical stimulation guidance may be useful when precise epidural blood patch placement is required. Objectif

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Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with spontaneous intracranial hypotension

Cited by 28 publications

References 9 publications

Case report: Delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy

Case report: Delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy

Spontaneous spinal liquor fistula: case report

Regional Anesthesia and Pain Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test)

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