Role of Conventional Dynamic Myelography for Detection of High-Flow Cerebrospinal Fluid Leaks
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ORIGINAL ARTICLE
Role of Conventional Dynamic Myelography for Detection of High-Flow Cerebrospinal Fluid Leaks Optimizing the Technique Eike I. Piechowiak1 · Katarzyna Pospieszny1 · Levin Haeni2 · Christopher M. Jesse2 · Giovanni Peschi3 · Pascal J. Mosimann1 · Johannes Kaesmacher1,3 · Pasquale Mordasini1 · Andreas Raabe2 · Christian T. Ulrich2 · Jürgen Beck2,4 · Jan Gralla1 · Tomas Dobrocky1 Received: 13 February 2020 / Accepted: 23 July 2020 © The Author(s) 2020
Abstract 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.
Keywords Spontaneous intracranial hypotension · CSF leak · Conventional dynamic myelography
Availability of data and material The datasets analyzed during the current study are not publicly available owing to preclusion from dissemination under Swiss Federal Law regulations; however, they are available from the corresponding author on reasonable request. Where not in conflict with constraints of the original ethical approval under which the data were collected, pseudoanonymized data will be made available for appropriate collaborative research, subject to appropriate ethical approval being gained for such use. Video online The online version of this article contains 4 videos. The article and the videos are online available (https://doi.org/ 10.1007/s00062-020-00943-w). The videos can be found in the article back matter as “Electronic Su
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