title: Use of flat panel DynaCT myelography to locate the site of CSF leak.
abstract: Spontaneous intracranial hypotension is often treated conservatively or with epidural blood patch. Patients who are resistant to these treatments require accurate imaging localisation of the site of cerebrospinal fluid (CSF) leak for surgical repair. We describe two patients where MRI, CT myelography and MRI gadolinium myelography showed evidence of a large volume of epidural CSF, but failed to identify the pressure site of leak. Subsequently, DynaCT (Siemens, Erlangen, Germany) accurately identified the site with confidence in both cases, confirmed at surgery. This technique of using a flat panel detector-based, angiographic system to produce high quality, high-contrast multiplanar CT images for detecting the source of rapid CSF leak is detailed.
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Chu
authors.forename: William
authors.initials: W
authors.lastname: McAuliffe
mesh_terms: D000328:Adult; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000295:instrumentation*; D011856:Radiographic Image Enhancement / Q000295:instrumentation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013353:Subdural Effusion / Q000150:complications* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D014963:X-Ray Intensifying Screens
keywords: CSF leak; DynaCT; cone-beam CT; flat panel detector; myelography; spontaneous intracranial hypotension