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Radiologie (Heidelberg, Germany) Oct 2022Imaging of the postoperative spine intends to answer two main questions: It is used to assess the surgical success and to identify complications. To this end,... (Review)
Review
Imaging of the postoperative spine intends to answer two main questions: It is used to assess the surgical success and to identify complications. To this end, conventional X‑ray, computer tomography (CT), myelography, and magnetic resonance imaging (MRI) are available. The radiologist has to select the appropriate modality for sufficient diagnosis considering the preoperative situation, the performed operation, and existing postoperative symptoms. Particularly, the implantation of foreign material represents a technical challenge in the context of image acquisition. In the radiologist's report, one must differentiate between expected postoperative changes and relevant complications. Close communication with the patients and the referring clinicians is essential. Especially clinical signs of infection, new or progressive neurological deficits and cauda equina and conus medullaris syndromes require an immediate diagnosis to facilitate prompt therapy.
Topics: Cauda Equina; Humans; Musculoskeletal System; Myelography; Spinal Cord Compression; Spine; Tomography, X-Ray Computed
PubMed: 35789426
DOI: 10.1007/s00117-022-01034-2 -
AJNR. American Journal of Neuroradiology Jul 2022Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further...
BACKGROUND AND PURPOSE
Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population.
MATERIALS AND METHODS
Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes.
RESULTS
A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (< .001) and coronal (< .001) planes.
CONCLUSIONS
Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.
Topics: Case-Control Studies; Cerebrospinal Fluid Leak; Craniofacial Abnormalities; Humans; Hyperostosis; Intracranial Hypotension; Magnetic Resonance Imaging; Myelography; Retrospective Studies
PubMed: 35772803
DOI: 10.3174/ajnr.A7557 -
Radiology Case Reports Sep 2022Spontaneous intracranial hypotension can be caused by spinal dural tears or CSF-venous fistulas. It is rare for patients to have more than one type of leak at any given...
Spontaneous intracranial hypotension can be caused by spinal dural tears or CSF-venous fistulas. It is rare for patients to have more than one type of leak at any given time. Here, we illustrate 3 examples of dural tears that co-existed with CSF-venous fistulas, with both being seen on dynamic CT myelography. To our knowledge, coexistent CSF-venous fistulas and dural tears have not been previously illustrated on dynamic CT myelography, even though this is one of the most commonly used modalities to work-up patients with CSF leaks. We discuss the clinical importance of the rare co-occurrence of these leaks with regard to diagnosis and treatment, as well as implications for understanding and classifying CSF leaks.
PubMed: 35755098
DOI: 10.1016/j.radcr.2022.05.053 -
AJNR. American Journal of Neuroradiology Jul 2022A spinal CSF-venous fistula is an increasingly recognized type of CSF leak that causes spontaneous intracranial hypotension. The detection of these fistulas requires...
A spinal CSF-venous fistula is an increasingly recognized type of CSF leak that causes spontaneous intracranial hypotension. The detection of these fistulas requires specialized imaging such as digital subtraction myelography or dynamic CT myelography, and several treatment options are available. A novel treatment for these CSF-venous fistulas consisting of transvenous embolization with the liquid embolic agent Onyx has been described recently, but some patients require further treatment if embolization fails. The purpose of this study was to evaluate the safety and effectiveness of surgery following transvenous embolization. In a series of 6 consecutive patients who underwent surgical ligation of the fistula after endovascular embolization, there were no surgical complications. Postoperatively, complete resolution of symptoms was reported by 5 of the 6 patients, and brain MR imaging findings of spontaneous intracranial hypotension resolved in all patients. This study suggests that surgical ligation of spontaneous spinal CSF-venous fistulas after endovascular embolization is effective and safe.
Topics: Cerebrospinal Fluid Leak; Embolization, Therapeutic; Fistula; Humans; Intracranial Hypotension; Myelography
PubMed: 35738676
DOI: 10.3174/ajnr.A7558 -
AJNR. American Journal of Neuroradiology Jul 2022There are 3 main types of spinal CSF leaks, and the imaging appearances are well-reported. Specific patient demographics and spinal locations of the various types of...
BACKGROUND AND PURPOSE
There are 3 main types of spinal CSF leaks, and the imaging appearances are well-reported. Specific patient demographics and spinal locations of the various types of spinal leaks are less frequently described. The purpose of this article was to stratify the various types of spontaneous CSF leaks on the basis of age, body mass index, and spinal level.
MATERIALS AND METHODS
Retrospective review was performed for all patients with spontaneous spinal CSF leaks identified on CT myelography. Age, body mass index, and spinal CSF leak type and level were recorded.
RESULTS
Sixty-five patients (37 women and 28 men) had spinal CSF leaks. Type 1 CSF leaks (dural tears) were observed in 25 patients (mean age, 44.5 years; mean body mass index, 24.3) and were most common in the upper thoracic spine (72%), particularly at the T1-T2 level (36%). Type 2 CSF leaks (ruptured meningeal diverticula) were observed in 4 patients (mean age, 45.5 years; mean body mass index, 27.5) and were all seen in the lower thoracic spine. Type 3 CSF leaks (CSF-venous fistulas) were observed in 36 patients (mean age, 58.8 years; mean body mass index, 27.0) and were most common on the right side (72%) and in the lower thoracic spine (56%).
CONCLUSIONS
Type 1 CSF leaks occurred in younger patients with a normal body mass index, while patients with type 3 CSF leaks were relatively older and had an elevated body mass index. Type 1 leaks mostly occurred in the upper thoracic spine, and types 2 and 3 leaks mostly occurred in the lower thoracic spine.
Topics: Adult; Body Mass Index; Cerebrospinal Fluid Leak; Diverticulum; Female; Humans; Intracranial Hypotension; Male; Meninges; Middle Aged; Myelography; Spine; Tomography, X-Ray Computed
PubMed: 35738670
DOI: 10.3174/ajnr.A7548 -
Veterinary Medicine and Science Jul 2022This report describes a spinal cord epidural and synovial lipomatosis in a 3-year-old neutered male Eurasian dog. This dog presented for ambulatory paraparesis and was...
This report describes a spinal cord epidural and synovial lipomatosis in a 3-year-old neutered male Eurasian dog. This dog presented for ambulatory paraparesis and was previously treated with immunosuppressive dosages of prednisolone for 2 years. Computed tomography (CT) myelography and magnetic resonnance imaging (MRI) images identified dorsal compression of the thoraco-lumbar spinal cord by hypertrophic epidural fat. Histological examination identified extensive well-differentiated mature adipose tissue in the subepithelial area of the tarsal synovium. Prednisolone is a reported predisposing factor in humans with lipomatosis.
Topics: Animals; Dog Diseases; Dogs; Epidural Space; Humans; Lipomatosis; Male; Myelography; Prednisolone; Steroids
PubMed: 35732060
DOI: 10.1002/vms3.842 -
Radiology Case Reports Aug 2022Neonatal obstetric brachial plexus palsy is common in newborns with fetal macrosomia, especially those who are delivered vaginally with shoulder dystocia or breech...
Neonatal obstetric brachial plexus palsy is common in newborns with fetal macrosomia, especially those who are delivered vaginally with shoulder dystocia or breech delivery. The anatomical structure of brachial plexus in newborns is thin, and it is neither collinear nor coplanar in space; The location, the type and degree of neonatal brachial plexus injury need to be comprehensively judged by clinical history, neurological and imaging examination. Conventional MR imaging is not sufficient to diagnose brachial plexus injury. In this case report, we describe the clinical and imaging data of a newborn with brachial plexus injury diagnosed by the fat-suppressed T2-weighted sequence and MR myelography and confirmed by surgery. In addition, we review the related literature in an attempt to provide a better understanding of the principles and characteristics of neonatal brachial plexus injury diagnosed by magnetic resonance neurography.
PubMed: 35711739
DOI: 10.1016/j.radcr.2022.04.017 -
Neurological Sciences : Official... Sep 2022BACKGROUND AND IMPORTANCE : Classical infratentorial superficial siderosis (iSS) is characterised by repeated insidious bleeding into the subarachnoid space, leading...
Targeted detection and repair of a spinal dural defect associated with successful biochemical resolution of subarachnoid bleeding in classical infratentorial superficial siderosis.
BACKGROUND AND IMPORTANCE : Classical infratentorial superficial siderosis (iSS) is characterised by repeated insidious bleeding into the subarachnoid space, leading to haemosiderin deposition within the subpial layers of the brainstem, cerebellum and spinal cord, sometimes with supratentorial involvement. Although nearly always associated with a dural defect (usually from previous trauma or neurosurgery) there is little evidence to support definitive investigation and management strategies. Here, we present a novel investigation strategy to identify a dural defect and subsequent successful surgical repair with biochemical resolution of subarachnoid bleeding. CLINICAL PRESENTATION: A 55-year-old gentleman presented with a 15-year progressive history of sensorineural deafness, followed by a slowly worsening gait ataxia. He had previously sustained cranio-spinal trauma. On examination there were features of myelopathy and ataxia. MRI demonstrated classical iSS, affecting cerebellum and cerebral cortices, with a cervicothoracic epidural CSF collection. Lumbar puncture (LP) revealed elevated ferritin 413 ng/mL and red cell count of 4160. Reverse CT myelography, a novel technique involving contrast injection into the collection, delineated a dural defect at the T9/T10 level that was not present on conventional myelography. Following surgical repair, repeat LP twelve months later demonstrated biochemical improvement (ferritin 18 ng/mL, red cells < 1). There was no further neurological deterioration in symptoms during eighteen months follow-up. CONCLUSION: We show the value of a rational targeted investigation pathway in identifying a surgically reparable dural defect underlying classical iSS. We also provide proof of concept that surgical repair can facilitate biochemical resolution of subarachnoid bleeding and might prevent progression of neurological disability.
Topics: Ferritins; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myelography; Siderosis; Subarachnoid Hemorrhage; Subarachnoid Space
PubMed: 35691973
DOI: 10.1007/s10072-022-06181-x -
Surgical Neurology International 2022Spontaneous intracranial hypotension (SIH) is a rare disease characterized by a decrease in the volume and pressure of cerebrospinal fluid (CSF) resulting from its...
BACKGROUND
Spontaneous intracranial hypotension (SIH) is a rare disease characterized by a decrease in the volume and pressure of cerebrospinal fluid (CSF) resulting from its leakage through the dura mater. SIH is curable, but it can lead to serious clinical sequelae or even death if not treated properly.
CASE DESCRIPTION
A 37-year-old female with headaches occurring in standing position and increasing especially during verticalization. Magnetic resonance imaging showed an image characteristic of SIH. Conservative treatment was applied in the form of bed rest. CT myelography scan located the site of CSF leakage. As the conservative treatment proved inefficient, it was decided to perform an epidural fistula sealing using the patient's venous blood, administered under computed tomography guidance. The performed procedure completely resolved the patient's complaints, allowing her to be discharged home.
CONCLUSION
Patients with suspected SIH should remain in the supine position until a definitive diagnosis is made. Sealing the meningeal fistula with venous blood under computed tomography guidance should be considered in case of conservative treatment failure.
PubMed: 35673655
DOI: 10.25259/SNI_360_2022 -
Surgical Neurology International 2022We describe a case of long-standing intracranial hypotension caused by an iatrogenic arachnoid diverticulum. This case illustrates two learning points. First, excessive...
BACKGROUND
We describe a case of long-standing intracranial hypotension caused by an iatrogenic arachnoid diverticulum. This case illustrates two learning points. First, excessive CSF absorption may occur through an acquired arachnoid-epidural venous plexus at a dural defect. Second, a long-standing CSF leak may benefit from definitive surgical repair in the first instance.
CASE DESCRIPTION
A 55-year-old female, with known idiopathic intracranial hypertension, presented with disabling chronic low-pressure symptoms after having a lumboperitoneal shunt removed 5 years previously. MRI scan revealed a Chiari I malformation (CMI) and a small dural interruption at the L3/4 space. CT myelography confirmed the abnormality. Intraoperatively, a dural defect and arachnoid bleb with an overlying attachment of adipose tissue and a vessel were found. Postoperatively, the patient has marked resolution of her headaches and dizziness and is mobilizing independently.
CONCLUSION
Excessive CSF absorption appears to have occurred through an acquired arachnoid-epidural venous plexus. A high index of suspicion for intracranial hypotension is required in patients with low pressure symptoms and a CMI.
PubMed: 35673636
DOI: 10.25259/SNI_1084_2021