Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Detection of Surgery-related Spinal Cerebrospinal Fluid Leakage Using Magnetic Resonance Myelography

자기공명척수조영술을 이용한 수술 후 척추 뇌수막액 누출 평가

  • Koo, Hyun Jung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Sang Joon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chung, Sun J. (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Rhim, Seung-Chul (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 구현정 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 김상준 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 정선주 (울산대학교 의과대학 서울아산병원 신경과) ;
  • 임승철 (울산대학교 의과대학 서울아산병원 신경외과)
  • Received : 2012.11.21
  • Accepted : 2013.01.30
  • Published : 2013.06.30
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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.

척추 수술의 합병증으로 뇌척수액 누출이 발생할 수 있는데 이를 영상학적으로 진단하는 것은 어려움이 있다. 이 연구에서는 자기공명척수조영술을 이용하여 척추 수술 후 뇌척수액 누출을 확인하였던 두 환자의 증례를 보고하고자 한다. 두 환자는 각기 요추 추간판 절제술과 척추 수막종 제거술을 받은 뒤 심한 두통을 호소하였다. 두 환자의 자기공명척수조영영상에서 척추 뇌수막액 누출 부위가 확인되었고, 이에 대해 환자들은 각각 epidural blood patch와 재수술을 받았다. 이 두 사례에서 자기공명척수조영술은 척추 뇌수막액의 누출 부위를 정확히 보여주었고, 척수강과 가성수막류 (pseudomeningocele) 사이의 교통로를 잘 나타내주었다. 척수 수술 후 뇌수막액 누출을 확인하기 위한 검사로 자기공명척수조영술이 유용한 것으로 생각된다.

Keywords

References

  1. Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A. Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine 2006;5:224-227 https://doi.org/10.3171/spi.2006.5.3.224
  2. Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE, Jr. Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 1989;14:443-446 https://doi.org/10.1097/00007632-198904000-00021
  3. Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurg 1992;30:241-245 https://doi.org/10.1227/00006123-199202000-00015
  4. Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 1981;63:1132-1136 https://doi.org/10.2106/00004623-198163070-00010
  5. Lauer KK, Haddox JD. Epidural blood patch as treatment for a surgical durocutaneous fistula. J Clin Anesth 1992;4:45-47
  6. El Gammal T, Sobol W, Wadlington VR, et al. Cerebrospinal fluid fistula: detection with MR cisternography. AJNR Am J Neuroradiol 1998;19:627-631
  7. Rabin BM, Roychowdhury S, Meyer JR, Cohen BA, LaPat KD, Russell EJ. Spontaneous intracranial hypotension: spinal MR findings. AJNR Am J Neuroradiol 1998;19:1034-1039
  8. Yoo HM, Kim SJ, Choi CG, et al. Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography. AJNR Am J Neuroradiol 2008;29:649-654 https://doi.org/10.3174/ajnr.A0920
  9. Katramados A, Patel SC, Mitsias PD. Non-invasive magnetic resonance myelography in spontaneous intracranial hypotension. Cephalalgia 2006;26:1160-1164 https://doi.org/10.1111/j.1468-2982.2006.01168.x
  10. Maycock NF, van Essen J, Pfitzner J. Post-laminectomy cerebrospinal fluid fistula treated with epidural blood patch. Spine 1994;19:2223-2225 https://doi.org/10.1097/00007632-199410000-00018
  11. Goldberg AL, Kershah SM. Advances in imaging of vertebral and spinal cord injury. J Spinal Cord Med 2010;33:105-116 https://doi.org/10.1080/10790268.2010.11689685
  12. Hashizume K, Watanabe K, Kawaguchi M, Fujiwara A, Furuya H. Comparison between computed tomography-myelography and radioisotope-cisternography findings in whiplash-associated disorders suspected to be caused by traumatic cerebrospinal fluid leak. Spine 2012;37:E721-726 https://doi.org/10.1097/BRS.0b013e31824ae5d1