施工実績

A CT myelogram could also be used to determine the website away from leak in those people having SS who have a longitudinally detailed fluid-occupied intraspinal collection and you will an effective suspected dural tear. During the time ranging from intrathecal compare shot around fluoroscopy and you will buy of CT images, there occurs equilibration from examine amongst the intradural and you can extradural CSF series. This is especially valid which have large problems otherwise multiple defects otherwise high-flow leakages. Active CT myelography by using multidetector CT and you will an effective workstation in a position to of producing multiplanar reconstructions will bring adequate temporal and you can spatial solution and you will is beat brand new limit viewed that have regime myelography otherwise program myelography having delay CT imaging directed at finding slow-circulate leaks. The practice of active CT myelography is actually produced having detection regarding leakages for the patients having impulsive intracranial hypotension. 56 Now, it has been familiar with select dural problems connecting the newest intrathecal area into the intraspinal water-filled collection present in customers that have SS (Fig 10D, E1 and E2) otherwise reasonable-pressure headache (Fig 10F1). 29

Angiography

Cerebral and you can spine angiography can be done investigations targeted at trying to find a keen occult supply of bleeding. These are generally unrewarding. Then it as a result of the slow and you can intermittent nature off new hemorrhaging. Further vascular malformations due to the fact a factor in persistent bleeding from inside the SS was unusual. The brand new recognition out of an excellent vascular malformation for the really works-upwards from someone which have SS will not necessarily mean you to the brand new aneurysm or arteriovenous anomaly is the way to obtain bleeding. This will be particularly so to own incidentally observed venous angiomas or unruptured aneurysms. Progression even with resection out of an enthusiastic arteriovenous fistula has also been advertised. 2 Vascular malformations that happen to be said in association with SS are cerebral arteriovenous malformations (AVMs), spinal AVMs, spinal arteriovenous fistula, aneurysms, and you may cavernous malformations. nine,sixteen,twenty-five,33,57 –sixty

Certain findings throughout neuroimaging for the SS get accidently highly recommend the option out of a main vascular malformation as a possible reason for chronic bleeding and you may punctual attention regarding analysis particularly MR otherwise conventional angiography. twenty-eight ) These are typically enhancement of your pial surface of the cable into the postgadolinium MR imaging effective out-of preferred boats (Fig 11A1, -A2) or perhaps the visibility out-of a popular motorboat otherwise an excellent CT myelogram (Fig 11B). The fresh new pathophysiology of the prominent ships in the place of vascular malformations viewed during the task-upwards regarding SS is not familiar. It has been suggested your pial siderosis will get subscribe to sclerosis of your own epidural plexus of veins, resulting in venous blood pressure level. twenty-eight The more has just advertised organization anywhere between SS and you will CSF hypovolemia keeps boosted the speculation that the improved CSF erythrocytes in the SS is due to intradural vascular engorgement that include CSF hypotension. 29,forty Imaging proof engorgement of intradural and you can epidural veins could possibly get rise above the crowd that have CSF hypovolemia (Fig 9C2 and you can C3). 40,61 Awareness of such relationships during the SS is very important whilst get obviate angiography.

A1 and A2, Postcontrast sagittal T1-adjusted cervical (A1) and thoracic (A2) MR photo within the the patient with SS tell you abnormal linear improvement over the ventral and dorsal cord surface (just like the person revealed into the 5A and you may B). B, CT myelogram in an individual which have SS suggests a great posterior dilated pial venous plexus extending from the foramen magnum to C7. It encouraged a mental and you will spinal angiography and this displayed zero abnormality. An effective reprinted having permission regarding Kumar N, McKeon A, Rabinstein AA, mais aussi al. Shallow siderosis and you can CSF hypovolemia: brand new problem (dural) from the hook up. Neurology 2007;–26 (Copyright laws 2007, Wolters Kluwer Health)

Most other Potential Procedure

Gadolinium-enhanced MR myelography and you may MR cisternography (MR imaging once intrathecal regarding gadolinium) try additional techniques which were the adult hub coupon regularly enhance the recognition regarding CSF leaks. 62,63 As well as said are electronic subtraction cisternography to understand intracranial CSF fistulas and electronic substraction myelography to determine good dural tear in the an individual with a good cervical postoperative pseudomeningocele. 64 –66 Into the an isolated declaration, digital substraction myelography has been utilized to recognize your website regarding a drip within the a patient which have SS and you will an excellent cervicothoracic epidural water collection (Fig 7C). 36