Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography

• DOI: 10.3174/ajnr.a6016
• Publication Date: 2019-03-28T17:55:13Z
• Authors: R.I. Farb; P.J. Nicholson; P.W. Peng; E.M. Massicotte; C. Lay; T. Krings; K.G. terBrugge
• Keywords: Intracranial Hypotension

<h3>BACKGROUND AND PURPOSE:</h3> Localization of the culprit CSF leak in patients with spontaneous intracranial hypotension can be difficult and is inconsistently achieved. We present a high yield systematic imaging strategy using brain spine MRI combined digital subtraction myelography for localization. <h3>MATERIALS METHODS:</h3> During 2-year period, at our institution underwent MR to determine presence or absence spinal longitudinal extradural collection. Digital was then performed positive collection primarily prone position negative lateral decubitus positions. <h3>RESULTS:</h3> Thirty-one consecutive were included. The site leakage definitively located 27 (87%). Of these, 21 categorized as having ventral (type 1, fifteen [48%]) dural tear 2; four [13%]). Ten CSF-venous fistula 3, seven [23%]) distal nerve root sleeve 4, one [3%]). locations 2 remain undefined due resolution before repeat myelography. In (7%) collection, could not localized. Nine (43%) treated successfully an epidural blood patch, 12 required operation. 10 (8 localized), none effectively all have undergone (<i>n</i> = 7) are awaiting 1) <h3>CONCLUSIONS:</h3> Patients best positioned may warrant additional attempts directed patch. evaluated positions reveal fistula, common this population. forgo further patch treatment go on surgical repair.