Diagnostic Yield of Intrathecal Gadolinium MR Myelography for CSF Leak Localization

2021 ◽  
Author(s):  
Ajay A. Madhavan ◽  
Carrie M. Carr ◽  
John C. Benson ◽  
Waleed Brinjikji ◽  
Felix E. Diehn ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Csf Leak ◽  
Leak Localization ◽  
Mr Myelography

The Utility of Computed Tomography and Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leak

2019 ◽  
Vol 34 (3) ◽  
pp. 342-347
Author(s):  
John P. Flynn ◽  
Anna Pavelonis ◽  
Luke Ledbetter ◽  
Vidur Bhalla ◽  
Sameer A. Alvi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Diagnostic Yield ◽  
Ct Imaging ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Slice Thickness ◽  
Leak Localization ◽  
Skull Base Defects

Background Intrathecal fluorescein (IF) has become a common tool for localization of cerebrospinal fluid (CSF) leak, but despite frequent use, IF lacks Food and Drug Administration approval. The diagnostic ability of high-resolution computed tomography (HRCT) has increased over several decades. Subspecialized rhinology training within otolaryngology has, similarly, allowed for dedicated skull base surgeons to become more adept at CSF leak localization. Objectives To evaluate the utility of HRCT and IF in CSF leak localization. To identify certain patient populations in which IF has added utility. To analyze the ability of fellowship-trained neuroradiologist and rhinologist to localize CSF leak sites. Methods Data were collected from a single, tertiary care academic institution. Patients admitted for CSF leak between 2003 and 2016 were included. Diagnostic yield of preoperative imaging and IF for identification of leak site was analyzed. Fellowship-trained neuroradiologist and rhinologist performed retrospective review of CT imaging and identified CSF leak sites. Results One hundred and two patients underwent CSF leak repair. Skull base defects were preoperatively localized to exact sinus on imaging report in 67% of patients. Preoperative imaging stratified by CT slice thickness of 0.625 mm identified leak site in 88.9% of cases. Blinded retrospective review by a neuroradiologist and rhinologist was able to localize the CSF leak to the correct or adjacent sinus in >80% of cases. IF was useful for intraoperative localization in 73% of cases. When preoperative imaging failed at leak site localization, IF was able to correctly identify leak site in 75% of cases. Conclusions The diagnostic yield of IF and CT imaging was equivalent, with each modality localizing leak site approximately two-thirds of the time. CT imaging with 0.625 mm slice thickness proved more efficacious in identification of skull base defects. IF demonstrated increased utility in instances where preoperative imaging has failed at leak site identification.

scholarly journals Detection of CSF Leak in Spinal CSF Leak Syndrome Using MR Myelography: Correlation with Radioisotope Cisternography

2008 ◽  
Vol 29 (4) ◽  
pp. 649-654 ◽  
Author(s):  
H.-M. Yoo ◽  
S.J. Kim ◽  
C.G. Choi ◽  
D.H. Lee ◽  
J.H. Lee ◽  
...  
Keyword(s):  
Csf Leak ◽  
Mr Myelography

scholarly journals Safety and efficacy of brainstem biopsy in children and young adults

2020 ◽  
Vol 26 (5) ◽  
pp. 552-562
Author(s):  
David S. Hersh ◽  
Rahul Kumar ◽  
Kenneth A. Moore ◽  
Luke G. F. Smith ◽  
Christopher L. Tinkle ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Target Selection ◽  
Outcome Data ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Posterior Fossa Decompression ◽  
Brainstem Lesion ◽  
Additional Procedure ◽  
Children And Young Adults ◽  
Brainstem Biopsy

OBJECTIVEBiopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection.METHODSAll patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected.RESULTSA total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9–14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis.CONCLUSIONSBrainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.

Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches

2020 ◽  
Vol 77 ◽  
pp. 110-115
Author(s):  
Bo Ram Kim ◽  
Joon Woo Lee ◽  
Eugene Lee ◽  
Yusuhn Kang ◽  
Joong Mo Ahn ◽  
...  
Keyword(s):  
Leak Detection ◽  
Csf Leak ◽  
Mr Myelography

The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography

Cephalalgia ◽  
2016 ◽  
Vol 36 (13) ◽  
pp. 1291-1295 ◽  
Author(s):  
Teshamae S Monteith ◽  
Stephen F Kralik ◽  
William P Dillon ◽  
Randall A Hawkins ◽  
Peter J Goadsby
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Ct Myelography ◽  
Leak Location ◽  
Perineural Cyst ◽  
Mr Myelography ◽  
Csf Leaks

Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.

scholarly journals MR Myelography for Identification of Spinal CSF Leak in Spontaneous Intracranial Hypotension

2014 ◽  
Vol 35 (10) ◽  
pp. 2007-2012 ◽  
Author(s):  
J.L. Chazen ◽  
J.F. Talbott ◽  
J.E. Lantos ◽  
W.P. Dillon
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Mr Myelography

Diagnostic Yield of Lateral Decubitus Digital Subtraction Myelogram Stratified by Brain MRI Findings

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011522
Author(s):  
Dong Kun Kim ◽  
Carrie M. Carr ◽  
John C Benson ◽  
Felix E. Diehn ◽  
Vance T. Lehman ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Brain Mri ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Diagnostic Study ◽  
Digital Subtraction ◽  
Mri Findings ◽  
Lateral Decubitus ◽  
Spine Mri

Objective:Assess the diagnostic yield of lateral decubitus digital subtraction myelography (LDDSM) and stratify LDDSM diagnostic yield by the Bern spontaneous intracranial hypotension (SIH) score of the pre-procedure brain MRI.Methods:This retrospective diagnostic study included consecutive adult patients investigated for SIH who underwent LDDSM. Patients without pre-procedure brain and spine MRI, and patients with extradural fluid collection on spine MRI (type 1 leak) were excluded. LDDSM images and brain MRIs were assessed by two independent blinded readers; a third reader adjudicated any discrepancies. Diagnostic yield of LDDSM was assessed, both overall and stratified by Bern SIH scoring.Results:Of the 62 patients included in this study, 33(53.2%) had a CSF leak identified on LDDSM. Right-sided leaks were more common (70.6%), and the most commonly identified levels of leaks were at T6, T7, and T10. No leak was found in any of the 9 patients with Bern SIH score of 2 or less. Of the 11 patients with Bern SIH score of 3-4, 5(45.5%) had a CSF leak identified, while of the 42 patients with Bern SIH score of 5 or higher, 28(66.7%) had a CSF leak identified.Conclusions:LDDSM has a high diagnostic yield for finding the exact location of spinal CSF leak, and the diagnostic yield increases with higher Bern SIH score. No leaks were found in patients with Bern SIH score of 2 or less, suggesting that foregoing invasive testing such as LDDSM in these patients may be appropriate unless accompanied by high clinical suspicion.Classification of Evidence:This study provides Class II evidence that for patients with suspected SIH, higher Bern SIH scores are associated with a greater likelihood of LDDSM-identified CSF leaks.

scholarly journals Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

2015 ◽  
Vol 123 (3) ◽  
pp. 732-736 ◽  
Author(s):  
Julius Griauzde ◽  
Joseph J. Gemmete ◽  
Aditya S. Pandey ◽  
Neeraj Chaudhary
Keyword(s):  
Normal Saline ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Csf Leak ◽  
Csf Leakage ◽  
Leakage Site ◽  
Safe Technique ◽  
Preservative Free ◽  
Mr Myelography

OBJECT A CSF leak can be difficult to locate in patients who present with spontaneous intracranial hypotension (SIH). The purpose of this case series was to describe the authors’ experience with intrathecal preservative-free normal saline challenge coupled with contrast-enhanced MR myelography (CEMRM), which was used to provoke and detect a CSF leakage site in patients with SIH. METHODS The authors performed a retrospective review of the records of patients who underwent preservative-free normal saline challenge followed by intrathecal gadolinium (Gd) contrast infusion and MR myelography from 2010 to 2012. RESULTS The records survey identified 5 patients who underwent 6 procedures. Intrathecal preservative-free normal saline challenge followed by CEMRM identified a CSF leak during 5 of the 6 procedures. Previous CT myelograms were available from 4 patients, which did not reveal a leakage site. A CT myelogram of 1 patient showed a single leak, but the authors’ saline challenge-CEMRM technique identified multiple additional leakage sites. Three patients exhibited transient postprocedural symptoms related to the saline infusion, but no long-term or permanent adverse effects related to the procedure were observed. CONCLUSIONS Instillation of preservative-free normal saline into the thecal sac followed by intrathecal Gd infusion is a safe technique that may increase the detection of a CSF leak on MR myelography images in patients with SIH.

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