Background

Spinal imaging is essential to identify and localize cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension (SIH) patients when targeted treatment is necessary.

Purpose

Provide an in-depth presentation of the conventional dynamic myelography (CDM) technique for localizing spinal CSF leaks in SIH patients.

Material and Methods

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.

Results

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).

Conclusion

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.

中文翻译：

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常规动态脊髓造影在检测高流量脑脊液泄漏中的作用：优化技术。

背景

当需要靶向治疗时，脊柱成像对于识别和定位自发性低颅压 (SIH) 患者的脑脊液 (CSF) 渗漏至关重要。

目的

深入介绍用于定位 SIH 患者脊髓 CSF 渗漏的传统动态脊髓造影 (CDM) 技术。

材料与方法

回顾性分析了 2013 年至 2019 年间在我们机构调查的 CDM 和脊髓后计算机断层扫描 (CT) 证实的连续 SIH 患者。审查了术中报告以确认 CDM 的准确性。

结果

总共包括 62 名患者（平均年龄 45 岁）；48 例腹侧硬膜撕裂，12 例脑膜憩室，2 例脊柱纵向硬膜外脑脊液收集阳性患者的部位仍不清楚。在第一次和第二次 CDM 期间分别有 43 名和 17 名患者发现了泄漏。CDM 的使用正确识别了除一名接受手术闭合的患者外的所有患者的 CSF 泄漏部位 (45/46, 98%)。平均透视时间为 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）。

结论

CDM 程序对包括硬脑膜撕裂和脊神经憩室在内的脊髓 CSF 渗漏定位具有很高的准确性。它是具有最高时间分辨率的技术，对呼吸伪影具有鲁棒性，在患者定位方面具有很大的灵活性，在辐射剂量方面优于其他动态检查，并且不需要全身麻醉。然而，对于 CSF 静脉瘘，其他动态检查，例如数字减影脊髓造影，似乎更合适。