Walker James B, Harkey H Louis, Buciuc Razvan
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Neurosurgery. 2008 Aug;63(2):E375; discussion E375. doi: 10.1227/01.NEU.0000312716.08933.C5.
Cerebrospinal fluid diversion from the cisterna magna has been described previously but has largely been abandoned because of high complication rates and anatomic constraints. Situations still remain in which this may be the best or only alternative. We describe the use of interventional magnetic resonance imaging (iMRI) for the application of this largely forgotten procedure.
A 28-year-old woman with a previously diagnosed malignant peripheral nerve sheath tumor of the thoracic spine presented with a refractory postoperative cerebrospinal fluid leak complicated by diffuse meningeal carcinomatosis. External lumbar drainage was unsuccessful because of complete tumor obliteration. An attempt at primary closure augmented with muscle flaps was also ineffective. Ventricular drainage was deferred because of concern for tumor seeding, thus necessitating a more aggressive approach.
The patient was intubated and placed in the open iMRI portal in a lateral decubitus position. Under direct image guidance, a closed-tip lumbar catheter was inserted into the cisterna magna through an iMRI-compatible biopsy needle and then connected for external drainage.
To our knowledge, this is the first described use of iMRI technology for catheterization of the cisterna magna for cerebrospinal fluid diversion. Moreover, iMRI technology should be considered in future applications of complex posterior fossa shunting procedures.
先前已有关于经枕大池进行脑脊液分流的描述，但由于高并发症发生率和解剖学限制，该方法在很大程度上已被摒弃。不过，仍存在一些情况，在此类情况下这可能是最佳或唯一的选择。我们描述了介入性磁共振成像（iMRI）在应用这一基本被遗忘的手术中的使用情况。
一名28岁女性，先前诊断为胸椎恶性外周神经鞘瘤，术后出现难治性脑脊液漏，并伴有弥漫性脑膜癌转移。由于肿瘤完全阻塞，腰椎外置引流失败。尝试采用肌瓣加强的一期缝合也无效。因担心肿瘤播散，推迟了脑室引流，因此需要采取更积极的方法。
患者插管后以侧卧位置于开放式iMRI检查门内。在直接图像引导下，通过与iMRI兼容的活检针将封闭头端的腰椎导管插入枕大池，然后连接进行外置引流。
据我们所知，这是首次描述使用iMRI技术经枕大池置管进行脑脊液分流。此外，在未来复杂的后颅窝分流手术应用中应考虑iMRI技术。
