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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1779629
Case Series

Management of Spontaneous Spinal CSF Leaks Using Noninvasive Dynamic MR Neurography: A Case Series

Prabhat Suman 
1   Department of Neurosurgery, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Rahul Lath
1   Department of Neurosurgery, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Alok Ranjan
1   Department of Neurosurgery, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Shekhar Reddy Gurrala
2   Department of Neuroanesthesia, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Kaushal Ipilli
1   Department of Neurosurgery, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Ravikanti Satya Prasad
3   Department of Radiodiagnosis, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
,
Tarang K. Vora
1   Department of Neurosurgery, Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India
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Abstract

Spontaneous spinal cerebrospinal fluid (CSF) leak presents with orthostatic headache and may lead to formation of subdural collection. Invasive magnetic resonance imaging or computed tomography myelography is routinely used to detect these leaks. Noninvasive dynamic magnetic resonance neurography can also detect these leaks and confirm its resolution post treatment. It includes three-dimensional NerveView, a high-resolution short-tau inversion recovery sequence for better visualization of spinal nerves and leak sites. This article showcases the diagnostic and therapeutic journey of three patients with spontaneous spinal CSF leak all of whom were diagnosed with dynamic magnetic resonance neurography and treated successfully with autologous targeted epidural blood patch. In one case, epidural blood patch was repeated after 2 months for recurrence of the leak.

Keywords

spontaneous spinal CSF leaks - subdural hematoma - dynamic MR Neurogram - epidural blood patch - spontaneous intracranial hypotension - meningeal diverticula - CSF-venous fistula - orthostatic headache

Consent to Publish

Informed consent was obtained from all individual participants to use MRI or CT images included in the study. Identifying information regarding participants is not included in the study.




Publication History

Article published online:
08 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Limaye K, Samant R, Lee RW. Spontaneous intracranial hypotension: diagnosis to management. Acta Neurol Belg 2016; 116 (02) 119-125
    Google Scholar
  • 2 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295 (19) 2286-2296
    Google Scholar
  • 3 D'Antona L, Jaime Merchan MA, Vassiliou A. et al. Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta- analysis. JAMA Neurol 2021; 78 (03) 329-337
    Google Scholar
  • 4 Sandow BA, Donnal JF. Myelography complications and current practice patterns. AJR Am J Roentgenol 2005; 185 (03) 768-771
    Google Scholar
  • 5 Luetzen N, Dovi-Akue P, Fung C, Beck J, Urbach H. Spontaneous intracranial hypotension: diagnostic and therapeutic workup. Neuroradiology 2021; 63 (11) 1765-1772
    Google Scholar
  • 6 Shah LM, McLean LA, Heilbrun ME, Salzman KL. Intracranial hypotension: improved MRI detection with diagnostic intracranial angles. AJR Am J Roentgenol 2013; 200 (02) 400-407
    Google Scholar
  • 7 Farb RI, Forghani R, Lee SK, Mikulis DJ, Agid R. The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol 2007; 28 (08) 1489-1493
    Google Scholar
  • 8 Wang DJ, Pandey SK, Lee DH, Sharma M. The interpeduncular angle: a practical and objective marker for the detection and diagnosis of intracranial hypotension on brain MRI. AJNR Am J Neuroradiol 2019; 40 (08) 1299-1303
    Google Scholar
  • 9 Kranz PG, Gray L, Malinzak MD, Amrhein TJ. Spontaneous intracranial hypotension: pathogenesis, diagnosis, and treatment. Neuroimaging Clin N Am 2019; 29 (04) 581-594
    Google Scholar
  • 10 Schievink WI, Maya MM, Jean-Pierre S, Nuño M, Prasad RS, Moser FG. A classification system of spontaneous spinal CSF leaks. Neurology 2016; 87 (07) 673-679
    Google Scholar
  • 11 Beck J, Raabe A, Schievink WI. et al. Posterior approach and spinal cord release for 360° repair of dural defects in spontaneous intracranial hypotension. Neurosurgery 2019; 84 (06) E345-E351
    Google Scholar
  • 12 Schievink WI. Spontaneous intracranial hypotension. N Engl J Med 2021; 385 (23) 2173-2178
    Google Scholar
  • 13 Urbach H. Intracranial hypotension: clinical presentation, imaging findings, and imaging-guided therapy. Curr Opin Neurol 2014; 27 (04) 414-424
    Google Scholar
  • 14 Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn) 2015; 21 (4 Headache): 1086-108 PubMed
    Google Scholar
  • 15 Schievink WI, Maya MM, Moser FG, Tourje J. Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg 2005; 103 (04) 608-613
    Google Scholar
  • 16 Schievink WI. Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol 2003; 60 (12) 1713-1718
    Google Scholar
  • 17 Martín-Noguerol T, Montesinos P, Hassankhani A, Bencardino DA, Barousse R, Luna A. Technical update on MR neurography. Semin Musculoskelet Radiol 2022; 26 (02) 93-104
    Google Scholar
  • 18 Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2012; 33 (03) 535-540
    Google Scholar
  • 19 Takahashi K, Mima T, Akiba Y. Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases. Neurol Med Chir (Tokyo) 2016; 56 (02) 69-76
    Google Scholar
  • 20 Dobrocky T, Grunder L, Breiding PS. et al. Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol 2019; 76 (05) 580-587
    Google Scholar