Gadolinium-Enhanced MR Cisternography to Evaluate Dural Leaks in Intracranial Hypotension Syndrome

Abstract

BACKGROUND AND PURPOSE:We evaluated the use of MR cisternography after intrathecal administration of gadopentetate dimeglumine to detect the presence and localization of CSF leaks in 19 patients diagnosed with spontaneous intracranial hypotension syndrome according to the criteria of International Headache Society.

Intrathecal Gadolinium-Enhanced MR Cisternography: A Comprehensive Review

“…1,2 Cisternographic studies have been in use for at least 50 years for the evaluation of abnormalities of the intracranial CSF-filled spaces, cranium base, and vertebral column; however, it is called "myelography" if it is dedicated to spinal canal investigation only. 1,2 In this review, different imaging techniques performed after intrathecal contrast agent administration will be called "cisternography. " The main limitations of RC are lack of cross-sectional images and lower spatial resolution.…”

“…CT has overcome these limitations; however, both CTC and RC involve radiation exposure, which is a more important factor to consider because cisternographic studies often require consecutive or multiple acquisitions. [2][3][4][5][6] NCE-MRC derived from heavily 3D T2-weighted sequences (such as fast imaging with steady state acquisition, CISS, or sampling perfection with application optimized contrast using different flip angle evolutions) has been developed to overcome the above-mentioned limitations of CTC and RC. [3][4][5] This technique can be helpful in investigating CSF leakage and the fluid dynamics of the ventricular system.…”

“…Intrathecal Gd injection is not approved by the FDA, though its safety has been reported in several pilot studies in Europe. [2][3][4]6,[9][10][11][12][13][14] Tolerance and dose limits of intrathecal Gd injection were established in animal model studies, and different Gd compounds (eg, gadodiamide, gadobenate dimeglumine, and Gd-DTPA) were compared in different experimental animal protocols. 5,[14][15][16][17] High-dose intraventricular Gd injection was reported to result in behavioral and neurologic disturbances (focal seizures, ataxia, latent tremor) with histopathologic changes (loss of oligodendroglia, astrocytic hypertrophy, and eosinophilia); on the other hand, it was concluded that these changes and distur-bance did not occur if the total injected dose wasϽ15 mL (3.3 mmol/g).…”

CT-guided percutaneous translaminar approach for blood patching: case report and technical note

“…Other symptoms, such as, vestibular and auditory symptoms due to variations in intra labyrinthine pressure [4], partial pituitary insufficiency due to traction of the pituitary stalk [12], cortical venous thrombosis due to the decreased venous blood flow velocity [15] and paroxysmal ataxia of gait [4] have been reported. In patients presenting with cranial neurological symptoms (especially orthostatic headache) after spinal surgery, IH syndrome is considered as a differential diagnosis and neuroimaging studies, such as, CT and MRI myelography and RC [1,10,11]. In our case, MRI myelography was not considered due to the presence of the spinal instrumentation, and we performed CT myelography which was successful in determining the site of the dural tear.…”

“…One of the causes of IH is spinal CSF leakage due to a dural tear complicating spinal surgeries [3,7]. Patients complaining of new onset neurological symptoms after spinal surgery, especially orthostatic headache, IH syndrome must be considered in the differential diagnosis, and neuroimaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) myelography and radionuclide cisternography (RC) must be performed accordingly [1]. Treatment modalities for IH include bed rest, intravenous fluid, intravenous or oral caffeine, theophylline, steroids, epidural blood patch (EBP) and surgical exploration.…”