![]() Detailed scanning parameters are summarized in the table. The patient underwent MR myelography to detect the leakage site, with 2D TSE and 3D balanced turbo field echo (BTFE) images obtained on the same 1.5-T scanner as in Patient 1. Spine MR revealed a localized fluid collection at the previous operation site with a compression fracture of the T12 superior aspect. A physical examination and laboratory tests showed no significant abnormal findings. She was therefore admitted to our institution. She underwent two additional operations, but her symptoms did not improve. After the operation, she developed orthostatic headache, suggesting postoperative CSF leakage. Six months earlier, she had undergone surgery to remove a spinal intradural extramedullary mass at the T11-12 level, which was pathologically confirmed as a meningioma. Her symptoms were relieved by the next day, and she was discharged without further events.Ī 64-year-old woman was admitted due to an orthostatic headache that developed after spinal surgery. The patient was promptly treated with an epidural blood patch targeted to the leakage site. We also observed diffuse hyperintensity in the left paravertebral area along the muscle bundles, representing local fluid accumulation secondary to CSF leakage ( Fig. MR myelography showed a small, hyperintense CSF leakage site at the left lateral aspect of the L4 level. The scanning parameters were summarized in the table. MR myelography was performed to detect possible CSF leakage using a 2-dimensional (D) turbo spin echo (TSE) technique on a 1.5-T scanner (Gyroscan Intera, Philips Medical Systems, Best, the Netherlands). 1b, c), but failed to detect exact leakage site. Axial T2 weighted images of conventional MR showed left paravertebral fluid collection ( Fig. Spinal MR imaging showed a hyperintense T2 signal at the discectomy site, suggesting postoperative changes ( Fig. Here, we describe two patients with surgery-related CSF leakage in whom the leakage sites were accurately detected on MR myelography.Ī 28-year-old woman developed severe headache accompanied by nausea and vomiting one day after a lumbar discectomy at L4-5 level for an intervertebral disc herniation. Among the diagnostic modalities used to determine the site of CSF leakage are magnetic resonance (MR) imaging, computed tomographic (CT) cisternography, and radioisotope cisternography. To provide appropriate treatment, it is essential to detect the exact site of CSF leakage. The usual treatment of CSF leakage consists of drainage of the CSF through a subarachnoid catheter ( 3) and surgical repair of the dural tear ( 4), although an epidural blood patch may also be used ( 5). The patient is likely to experience symptoms of CSF hypovolemia, including postural headache plus nausea, vomiting, pain or tightness in the neck or back, dizziness, diplopia, photophobia, tinnitus, and/or blurred vision. ![]() ![]() An incidental dural tear resulting in cerebrospinal fluid (CSF) leakage is a complication of spinal surgery, with a reported incidence of between 0.3% and 16% ( 1, 2). ![]()
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