Abstract Details

Title Localization of Cerebrospinal Fluid Leak with Digital Subtraction Myelography

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 258

Objective

Background BACKGROUND: Conventional imaging modalities such as computed tomography (CT) myelogram and magnetic resonance (MR) imaging are limited by lack of temporal resolution in precise localization of dural tears. Rapid and voluminous CSF leaks also present a problem while using these conventional methods.

Design/Methods DESIGN/METHODS: Our interventional neurology team performed DS myelography in 37 year old male with history of migraines who presented with sudden onset intractable neck pain, stiffness and positional headache suggestive of CSF leak. DS myelography was performed using an SL 10 microcatheter inserted over an Agility 14 microwire under fluoroscopy through a micropuncture sheath advanced into the thecal sac using 20 gauge lumbar puncture needle. The catheter and wire were repositioned whenever the patient complained of pain secondary to impingement upon the nerve roots. The SL 10 catheter was advanced carefully in the subarachnoid space to the T9 vertebral level with planned DS angiography.

Results RESULTS: Initial investigations including CSF analysis, CT and MR imaging, and NM cisternogram were inconclusive to ascertain other etiologies such as infection and hemorrhage and also were unhelpful in localizing the site of CSF leak. Patient did not show any improvement after an empiric lumbar blood patch. Subsequently, DS angiography revealed extravasation of omnipaque contrast from the ventral surface of the thecal sac into the epidural space at T10 vertebral level. Consequently, a thoracic epidural blood patch was done which sealed the CSF leak and completely alleviated symptoms.

Conclusions CONCLUSIONS: Digital subtraction myelography is a valuable diagnostic tool for localization of rapid spinal CSF leaks. It is relatively safe and can be performed with ease in patients who have clinical presentation of spinal dural tears that cannot be identified with conventional imaging modalities.

Authors/Disclosures
PRESENTER	No disclosure on file
Vikram Jadhav, MD (Minnesota Stroke Network)	No disclosure on file
	No disclosure on file
	No disclosure on file
Virginia Lee, PhD (University of Pennsylvania)	Virginia Lee, PhD has nothing to disclose.

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