J Korean Soc Magn Reson Med.  2013 Jun;17(2):149-153. 10.13104/jksmrm.2013.17.2.149.

Detection of Surgery-related Spinal Cerebrospinal Fluid Leakage Using Magnetic Resonance Myelography

• Koo HJ
• Kim SJ
• Chung SJ
• Rhim SC

• KMID: 2099874
• DOI: http://doi.org/10.13104/jksmrm.2013.17.2.149

Abstract

Detection of cerebrospinal fluid leakage or exact localization of leakage site after spinal surgery is difficult on conventional imaging studies. We report two patients with surgery-related spinal CSF leakage detected on magnetic resonance (MR) myelography. They presented with severe headache after spinal surgeries, lumbar discectomy and excision of spinal meningioma, respectively. The sites of spinal CSF leakage in the patients were detected accurately on MR myelography, and the patients recovered from the postoperative CSF leakage after being treated with an epidural blood patch or reoperation. MR myelography may be effective in demonstrating the exact site of surgery-related spinal CSF leakage.

Keyword

MR myelography; Spinal CSF leakage; Spinal surgery; Cerebrospinal fluid leakage

MeSH Terms

Blood Patch, Epidural
Diskectomy
Headache
Humans
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Meningioma
Myelography
Reoperation

Figure

• 

  Fig. 1 Patient 1, a 28-year-old woman who developed orthostatic headache after endoscopic lumbar discectomy at the L4-5 level. a. T2-weighted sagittal image shows a focal hyperintense lesion (arrow) at the discectomy site at L4-5, with most changes being postoperative. b, c. L4-5, L5-S1 level axial T2-weighted images show left paravertebral fluid collection (arrowheads) but fail to visualize exact leakage site. d. 2D TSE coronal MR myelography shows the CSF leakage site (arrows) at the left side of the L4 level with paravertebral fluid collection (arrowheads) along the left paravertebral muscles.

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  Fig. 2 Patient 2, a 64-year-old woman with orthostatic headache after resection of an intradural meningioma. (a) Postoperative T2-weighted sagittal image shows extradural fluid collection (arrow), but not the exact site of communication. 2D TSE sagittal (b) and MIP image of 3D BTFE MR myelography (c) show communication at the T12 level (arrow). (d) Axial reconstructed 3D BTFE image showing the defect on the left side of the thecal sac. (e) Intraoperative photograph of patient 2 shows that the dural defect (arrowheads) was located on the left side of dural sac and measured about 20 mm in length. The spinal cord is visible through the defect (Direction; H: head, F: foot).

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