Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

Abstract

In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery.

Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

“…This mechanism may be especially relevant in the setting of the hyperemic inflammatory response in a postsurgical setting and potential for opioid induced constipation in postoperative patients. Additionally, the extravasation of fluid from small, delicate subdural veins explains the contrast enhancement seen in our case and documented in previous reports of SSH (19,20).…”

“…SSH crowds the cauda equina roots, though perhaps without the significant displacement common to epidural compression, generally most significant dorsal to the thecal sac (18). Enhancement with gadolinium contrast is variably reported (17,19,20), though may be useful in making the radiographic distinction between hygroma and effusion (21).…”

MRI diagnosis of spinal metastasis of medulloblastoma. A clinical case and literature review

“…Описанные нами в спинном мозге образования в англоязычной литературе называют по-разному: «субдуральное накопление контраста» (subdural contrast enchancement) [1,3,4], «послеоперационное интраспинальное субдуральное скопление» (postoperative intraspinal subdural collection -PISC) или даже «контраст-позитивное послеоперационное ин-траспинальное субдуральное скопление» (PISC+). Мы предлагаем термин «послеоперационное кон-траст-позитивное утолщение мозговых оболочек», как наиболее точный.…”

“…При непра-вильной интерпретации МРТ-картины контраст-позитивные утолщения мозговых оболочек оши-бочно расцениваются как метастазы опухоли М3-стадии, и больной переводится на более интенсив-ное лечение. Образования самостоятельно исчеза-ют или значительно уменьшаются через 2-3 нед, хотя могут обнаруживаться и в значительно более поздние сроки [1,[3][4][5].…”

Features of a technique of magnetic resonance imaging of the brain and spinal cord in children with neoplasms of the central nervous system

“…При опухолевых поражениях ЦНС МРТ являет-ся наиболее информативным методом диагностики [1,2]. Он применяется для выявления опухолевого поражения и дифференциальной диагностики с дру-гими поражениями ЦНС, определения локализации и взаимного расположения с различными анатоми-ческими структурами, размеров и объема опухоли, ее структуры, выявления возможных метастазов в веще-стве мозга и по мозговым оболочкам [3].…”