Localization of dural fistulas using metrizamide digital subtraction fluoroscopic cisternography

Takahashi, Tatsuo; Mutsuga, Naomi; Aoki, Toshiki; T, Handa; Tanoi, Chiharu; Yoshida, Jun; Kobayashi, T

doi:10.3171/jns.1988.68.5.0721

Cited by 17 publications

(5 citation statements)

References 11 publications

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“…In the early posttraumatic stage (Յ 3 months posttrauma) radiographic demonstration of an active CSF fistula by contrast-enhanced cisternography (CCG) was not helpful; this agrees with findings of other studies suggesting that the CCG may gradually be replaced by delineating the bone defect on coronal CT scanning. 27 Direct, dynamic real-time visualization of the fistula is difficult 18,25 unless the CSF leak occurs during the examination, 17 and digital subtraction used during the nondrip period may fail to reveal the site of the fistula. 3,27 However, compared with coronal CT scanning, CCG may be more helpful in the management of compound skull base fractures after the early posttraumatic stage.…”

Section: High-resolution Coronal Ct Scanning Compared With Other Imagmentioning

confidence: 99%

“…Instead, surgical decision making is primarily guided by whether the fracture is associated with persistent cerebrospinal fluid (CSF) rhinorrhea. 1,4,25 Rhinorrhea or tension pneumocele, however, can develop many (5-45) years after injury, 8,9,13,14,16,19,21,22 and a fatal attack of pneumococcal meningitis, without preced-ing CSF rhinorrhea, may be the first presentation of a posttraumatic fistula. 8 The reasons for poor healing in such cases are not fully understood.…”

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confidence: 99%

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Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair

Sakas

Beale²,

Ameen³

et al. 1998

Journal of Neurosurgery

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In this series, microsurgical repair was accompanied by a minimum complication rate. Hence, the authors recommend that patients with fractures that combine the aforementioned variables should be considered to have a high long-term risk of infection and their injury should be surgically repaired as soon as the posttraumatic edema has subsided. This applies to the following fractures: large cribriform (Type I) with transient rhinorrhea lasting 5 to 8 days and large frontoethmoidal (Type II) with prolonged rhinorrhea lasting longer than 8 days. Furthermore, the authors conclude that this classification can improve the management of posttraumatic CSF fistulas of the anterior cranial base and may provide insights into the mechanisms underlying their spontaneous repair and susceptibility to meningitis.

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Section: High-resolution Coronal Ct Scanning Compared With Other Imagmentioning

confidence: 99%

mentioning

confidence: 99%

Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair

Sakas

Beale²,

Ameen³

et al. 1998

Journal of Neurosurgery

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“…Digital subtraction cisternography has been reported as a useful technique to identify intracranial CSF fistulas. [6][7][8] More recently, digital subtraction myelography was successfully used to localize the dural tear in the case of a high cervical postoperative pseudomeningocele. Fig 1. A, Sagittal T2-weighted (TR, 3300 msec; TE, 100.8 msec) image of the thoracic spine defines the caudal aspect of the epidural fluid collection at T6 -T7.…”

Section: Discussionmentioning

confidence: 99%

Localization of a Rapid CSF Leak with Digital Subtraction Myelography

Hoxworth¹,

Patel²,

Bosch³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:A 53-year-old woman with superficial siderosis underwent spinal MR imaging, which demonstrated a large cervicothoracic epidural fluid collection compatible with a CSF leak. Conventional and dynamic CT myelography failed to localize the dural tear because of rapid equilibration of myelographic contrast between the thecal sac and the extradural collection. The superior temporal resolution of digital subtraction myelography precisely localized the CSF leak preoperatively and led to the successful surgical correction of the dural tear.O ne limitation of CT myelography to identify a CSF leak is temporal resolution. During the time elapsed from intrathecal contrast injection under fluoroscopy to acquisition of the CT images, equilibration of contrast between intradural and extradural CSF collections occurs. When the extradural CSF collection is large, localizing the responsible dural tear can be challenging as a result. Dynamic CT myelography has been used to overcome this problem 1 but still has temporal limitations inherent to the volume of tissue that must be imaged. We describe the case of a patient in whom chronic bleeding from a thoracic dural tear was the presumptive cause of superficial siderosis. The site of the tear was not adequately defined by myelography, postmyelography CT, or dynamic CT myelography, but digital subtraction myelography provided accurate preoperative localization. Case ReportA 53-year-old woman with progressive impaired balance, hearing loss, lower extremity numbness, and chronic daily headaches for the past 5 years underwent neurologic evaluation at our institution. On physical examination, the salient abnormalities included brisk reflexes in both upper and lower limbs, mute plantar responses, asymmetric impairment to light-touch and pin-prick sensation in both legs below the groin, prominent dysmetria on heel-to-shin testing, a widebased ataxic gait, and positive Romberg test. An audiogram confirmed right-greater-than-left sensorineural hearing loss. Tibial somatosensory-evoked responses revealed a prolonged lumbar-scalp interpeak latency suggesting a central conduction delay. The results of an atraumatic lumbar puncture included 1ϩ xanthochromia, 48 red blood cells per microliter, elevated protein of 122 mg/dL, and hemosiderin-containing macrophages.MR imaging of the brain and entire spine revealed prominent T2 shortening along the surface of the cerebellum, brain stem, and spinal cord consistent with susceptibility from hemosiderin deposition. A nonenhancing ventral epidural spinal fluid collection extended from the inferior aspect of C4 through the T6 -T7 disk space ( Figs 1A, -B). Moreover, a T2 hypointense fluid-fluid level suggestive of blood products was layering dependently in the distal thecal sac (not shown).Results of 3D time-of-flight head MR angiography were unremarkable. Because gadolinium-enhanced MR angiography of the spine suggested mildly prominent and serpiginous vessels along the dorsal aspect of the distal cord, the patient underwent catheter spinal angiogra...

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“…Fluorescein dyes, 19 radioisotopes, 20 metrizamide digital video subtraction fluoroscopic cisternography, 21 and contrast CT cisternography, 20,22,23 have all been used to determine the location of CSF leak. The latter, however, has proved invaluable, and is the test of choice.…”

Section: Discussionmentioning

confidence: 99%

Nontraumatic (Spontaneous) Cerebrospinal Fluid Rhinorrhea from Cribriform Fistula Associated with Primary Empty Sella: Report of Two Cases and Literature Review

Syed

2000

Ann Saudi Med

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Localization of dural fistulas using metrizamide digital subtraction fluoroscopic cisternography

Cited by 17 publications

References 11 publications

Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair

Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair

Localization of a Rapid CSF Leak with Digital Subtraction Myelography

Nontraumatic (Spontaneous) Cerebrospinal Fluid Rhinorrhea from Cribriform Fistula Associated with Primary Empty Sella: Report of Two Cases and Literature Review

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