University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clin Neuroradiol. 2021 Sep;31(3):633-641. doi: 10.1007/s00062-020-00943-w. Epub 2020 Aug 26.
Spinal imaging is essential to identify and localize cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension (SIH) patients when targeted treatment is necessary.
Provide an in-depth presentation of the conventional dynamic myelography (CDM) technique for localizing spinal CSF leaks in SIH patients.
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.
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).
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.
在自发性颅内低血压（SIH）患者需要靶向治疗时，脊柱成像对于识别和定位脑脊液（CSF）漏非常重要。
深入介绍用于定位 SIH 患者脊柱 CSF 漏的常规动态脊髓造影（CDM）技术。
回顾性分析了 2013 年至 2019 年在我院接受 CDM 和脊髓造影后 CT（postmyelography CT）检查并确诊 CSF 漏的连续 SIH 患者。审查了手术报告以确认 CDM 的准确性。
共纳入 62 例患者（平均年龄 45 岁）；48 例为腹侧硬脑膜撕裂，12 例为脑膜憩室，2 例为脊髓纵向硬膜外 CSF 积聚，部位仍不清楚。43 例患者在第一次和 17 例患者在第二次 CDM 中识别出漏口。除 1 例接受手术闭合的患者（45/46，98%）外，所有患者均使用 CDM 正确识别了 CSF 漏口的位置。透视时间的平均值为 7.8 分钟（范围 1.8-14.4 分钟），单次检查的辐射剂量为 310 mGy（范围 28-1237 mGy）。
CDM 程序对硬脑膜撕裂和脊髓神经憩室等脊柱 CSF 漏定位具有很高的准确性。它是时间分辨率最高的技术，对呼吸伪影具有较强的鲁棒性，允许患者体位非常灵活，与其他动态检查相比具有较低的辐射剂量，并且不需要全身麻醉。然而，对于 CSF 静脉瘘，其他动态检查，如数字减影脊髓造影，似乎更为合适。
