Intracranial hypotension is a rare cause of persistent headache originating mostly from a dural CSF leak. Conservative treatment serves as first-line therapy, but if it fails, a minimally invasive epidural blood patch (EBP) can lead to successful sealing of such a leak. The usual treatment is a blind EBP at the lumbar level.

MRI of the brain is used routinely to diagnose intracranial hypertension, but spinal MRI for the detection of the leakage site has attracted less attention due to its limited ability to identify the site of the leak.

CT myelography is still the diagnostic tool of choice, as it can show the location and extent of CSF leaks with high accuracy.

In clinical practice we found that EBP treatment immediately after diagnostic CT myelography is preferable to diagnostic myelography and EBP treatment separated by time.

In our study, we used the diagnostic CT myelography images to first detect the dural leakage, and we then applied immediately a targeted EBP at the corresponding level. This method increased the chances of success and permitted reduction of the applied blood volume. Furthermore, our technique improves the safety of epidural puncture in critical regions, eg, at the cervical level, because the contrast-enhanced CSF makes it easier to puncture the epidural space without violating the dura/spinal cord.

In clinical practice we found that the advantageous visualization properties of this combined diagnosis-and-treatment scheme optimize the rate of successful treatment. Particularly for radiologists who do not have to deal with CSF leaks on a regular basis, this method could be of great help.

 

Read this article at AJNR.org . . .