title: Application of time-spatial labeling inversion pulse magnetic resonance imaging in the diagnosis of spontaneous intracranial hypotension due to high-flow cerebrospinal fluid leakage at C1-2.
abstract: BACKGROUND
  Spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid (CSF) leakage at C1-2 poses diagnostic and therapeutic challenges to spine surgeons. Although computed tomography (CT) myelography has been the diagnostic imaging modality of choice for identifying the CSF leakage point, extradural CSF collection at C1-2 on conventional CT myelography or magnetic resonance imaging (MRI) may often be a false localizing sign.
  
  
  METHODS
  The present study reports the successful application of time-spatial labeling inversion pulse (T-SLIP) MRI, which enabled the precise identification of the CSF leakage point at C1-2 in a 28-year-old woman with intractable SIH. After identifying the leakage point using both CT myelography and T-SLIP MRI, surgery was performed to seal the CSF leak. Intraoperatively, a pouch suggestive of an extradural arachnoid cyst around the left C2 nerve root was found, which was repaired by packing the pouch with muscle and fibrin glue. Clinical improvement was observed shortly after surgery, and postoperative imaging revealed the disappearance of the CSF leakage.
  
  
  CONCLUSIONS
  T-SLIP MRI may provide useful information on the flow dynamics of CSF in SIH patients due to high-flow leakage. However, further experience is required to assess its sensitivity and specificity as an imaging modality for identifying CSF leakage points.
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakae
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
authors.affiliation: Department of Diagnostic Radiology, Fujita Health University Hospital, Toyoake, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Murayama
keywords: C1-2; CT myelography; cerebrospinal fluid leakage; spontaneous intracranial hypotension; time-spatial labeling inversion pulse (T-SLIP) MRI