Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes
- 1 March 2015
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Spine
- Vol. 22 (3), 324-331
- https://doi.org/10.3171/2014.10.spine14209
Abstract
Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes.This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37-74 years). The value of ultrafast dynamic CT myelography in depicting the CSF leak site was qualitatively assessed.In all 14 patients, ultrafast dynamic CT myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thoracic, and 0 lumbar levels, with 86% of the leaks occurring from C-5 to T-7. Information obtained from the ultrafast dynamic CT myelogram was considered useful in all treated CSF leaks.Spinal osteophytes piercing the dura are a more frequent cause of high-flow CSF leaks than previously recognized. Ultrafast dynamic CT myelography adds value beyond standard dynamic myelography or digital subtraction myelography in the diagnosis and anatomical characterization of high-flow spinal CSF leaks caused by these osteophytes. This information allows for appropriate planning for percutaneous or surgical treatment.Keywords
This publication has 11 references indexed in Scilit:
- When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial HypotensionAmerican Journal Of Neuroradiology, 2011
- The Role of MR Myelography with Intrathecal Gadolinium in Localization of Spinal CSF Leaks in Patients with Spontaneous Intracranial HypotensionAmerican Journal of Neuroradiology, 2011
- Idiopathic Thoracic Spinal Cord Herniation: Retrospective Analysis Supporting a Mechanism of Diskogenic Dural Injury and Subsequent Tamponade: Fig 1.American Journal of Neuroradiology, 2011
- Localization of a Rapid CSF Leak with Digital Subtraction MyelographyAmerican Journal of Neuroradiology, 2008
- Intracranial hypotension with spinal pathologyThe Spine Journal, 2006
- Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial HypotensionJAMA, 2006
- Role of dynamic CT myelography in identifying the etiology of superficial siderosisNeurology, 2005
- Idiopathic Spinal Cord Herniation Associated With Calcified Thoracic Disc Extrusion-Case Report-Neurologia medico-chirurgica, 2003
- Surgical Treatment of Nonatherosclerotic Lesions of the Extracranial Carotid ArteryNeurosurgery Clinics of North America, 2000
- Spontaneous Cerebrospinal Fluid Leaks: From Intracranial Hypotension to Cerebrospinal Fluid Hypovolemia—Evolution of a ConceptMayo Clinic Proceedings, 1999