Madhavan Ajay A, Kranz Peter G, Carlton Jones Lalani, Ahn Edward S, Amrhein Timothy J, Brinjikji Waleed, Callen Andrew, Cutsforth-Gregory Jeremy K, Mamlouk Mark D, Silvera V Michelle, Guerin Julie B
From the Division of Neuroradiology (A.A.M., W.B., V.M.S., J.B.G.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
Division of Neuroradiology (P.G.K., T.J.A.), Department of Radiology, Duke Health, Durham, North Carolina.
AJNR Am J Neuroradiol. 2024 Dec 9;45(12):1921-1927. doi: 10.3174/ajnr.A8430.
Spontaneous intracranial hypotension is an increasingly recognized syndrome caused by a spinal CSF leak, with most reported cases occurring in adults. The use of specialized or advanced myelography to localize spinal CSF leaks has evolved substantially in recent years, particularly since the initial description of CSF-venous fistulas in 2014. To our knowledge, no prior series have evaluated the use of specialized myelographic techniques to localize CSF leaks in children with spontaneous intracranial hypotension, likely because the disease is rare in this patient population. This issue may be compounded by a hesitation to perform invasive procedures in children. In this clinical report, we conducted a multi-institutional review of pediatric patients with spontaneous spinal CSF leaks localized using advanced myelographic techniques, such as prone and decubitus digital subtraction and CT myelography, as well as dynamic CT myelography. We report the clinical features of these patients, as well as imaging findings, types of leaks discovered, and method of treatment. We found that the primary types of spontaneous spinal CSF leaks that occur in adults, including dural tears and CSF fistulas, can be seen in children, too. Furthermore, we show that specialized myelographic techniques can successfully localize these leaks and facilitate effective targeted treatment.
自发性颅内低压是一种因脊髓脑脊液漏引起的、越来越被人们认识到的综合征，大多数报道的病例发生在成年人中。近年来，用于定位脊髓脑脊液漏的专门或先进的脊髓造影技术有了很大发展，特别是自2014年首次描述脑脊液静脉瘘以来。据我们所知，此前没有系列研究评估过使用专门的脊髓造影技术来定位儿童自发性颅内低压患者的脑脊液漏，可能是因为这种疾病在该患者群体中很罕见。在儿童中进行侵入性操作的顾虑可能会使这个问题更加复杂。在本临床报告中，我们对使用俯卧位和卧位数字减影以及CT脊髓造影等先进脊髓造影技术定位的儿童自发性脊髓脑脊液漏患者进行了多机构回顾，以及动态CT脊髓造影。我们报告了这些患者的临床特征、影像学表现、发现的漏口类型和治疗方法。我们发现，成年人中发生的自发性脊髓脑脊液漏的主要类型，包括硬脑膜撕裂和脑脊液瘘，在儿童中也可见。此外，我们表明专门的脊髓造影技术可以成功定位这些漏口并促进有效的靶向治疗。
