Yonemori Terutake, Karibe Hiroshi, Matsuno Futoshi, Honmou Osamu, Minamida Yoshihiro, Uede Teiji, Tanabe Sumiyoshi, Hashi Kazuo
Department of Neurosurgery, Sapporo Medical University School of Medicine, Japan.
No Shinkei Geka. 2002 Jun;30(6):617-21.
The authors report on a patient with postoperative CSF (cerebrospinal fluid) leakage subsequent to transsphenoidal surgery where cisterno SPECT (single photon emission computed tomography) demonstrated the precise location of a CSF fistula. Seven months after surgery, the patient suffered from CSF rhinorrhea and headache. MRI (Magnetic Resonance Imaging) revealed significant contrast on T1-weighted images resulting from measurements in the right sphenoid sinus, which were hyperintense relative to CSF. On the basis of signal intensity differences, MRI could not distinguish between CSF leakage and postoperative scarring. Therefore, we performed cisterno SPECT at the same time as RI cisternography with intrathecal lumbar injection of 111In-DTPA which revealed dramatic accumulation of the tracer in the right sphenoid sinus. The patient underwent re-operation via a transsphenoidal approach, and the CSF leakage was repaired using fat-in-fibrin glue and the sella floor was reconstructed by hydroxyapatite platinge. These results suggest that cisterno SPECT may be useful in identifying the precise location of CSF fistulae, while other techniques fail to show evidence of CSF leakage.
作者报告了一例经蝶窦手术后出现脑脊液漏的患者，脑池单光子发射计算机断层扫描（SPECT）显示了脑脊液瘘的精确位置。术后七个月，患者出现脑脊液鼻漏和头痛。磁共振成像（MRI）显示右侧蝶窦测量结果在T1加权图像上有明显对比，相对于脑脊液呈高信号。基于信号强度差异，MRI无法区分脑脊液漏和术后瘢痕形成。因此，我们在进行MRI脑池造影的同时进行脑池SPECT，经鞘内腰椎注射111铟-二乙三胺五乙酸（111In-DTPA），结果显示示踪剂在右侧蝶窦中显著积聚。患者通过经蝶窦入路再次手术，使用脂肪-纤维蛋白胶修复脑脊液漏，并采用羟基磷灰石板重建蝶鞍底。这些结果表明，脑池SPECT在确定脑脊液瘘的精确位置方面可能有用，而其他技术未能显示脑脊液漏的证据。
