Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewCerebrospinal Fluid Pressure Measurement and Infusion Studies Using Lumbar Puncture.
Lumbar puncture provides an easy way of accessing the subarachnoid space. Measuring of the opening cerebrospinal fluid pressure is the most commonly used method of evaluating intracranial pressure but provides basic snapshot information only. Further insights into cerebrospinal fluid dynamics can be obtained through infusion studies, which rely on measurement of the degree of pressure change in response to addition of fluid volume into the subarachnoid space. The authors describe applications of these 2 techniques pertinent to a practicing neuroradiologist, who may be asked to assist with fluoroscopy-guided lumbar puncture in patients with increased body mass index or difficult spine anatomy.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewImage-guided Access to the Spinal Subarachnoid Space in Children.
Image guidance is becoming standard of practice for cerebrospinal fluid sampling in children to improve success rates and avoid complications. This article discusses various imaging guidance techniques available in the pediatric age group. For neonates and infants, imaging guidance using ultrasound is the technique of choice, and for older children, fluoroscopy or even cone beam computed tomography can be used when anatomy is complex.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewCauses of Intracranial Hypotension: Spontaneous, Traumatic, and Iatrogenic Cerebrospinal Fluid Leaks.
Cerebrospinal fluid leaks are important to recognize because they can cause debilitating symptoms for patients and have life-threatening complications. Leakage of cerebrospinal fluid (CSF) from the subarachnoid space can occur at the cranial or spinal level, with distinct clinical presentations, diagnostic evaluations, and treatment modalities depending on the type and location of the leak. Spontaneous, traumatic, and iatrogenic spinal CSF leaks cause reduced intracranial CSF volume and the clinicoradiologic syndrome commonly called "intracranial hypotension". This review discusses the clinical presentations, etiologies, and risk factors of spinal and cranial CSF leaks.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewMyelographic Techniques for the Localization of Cerebrospinal Fluid Leaks.
Spinal cerebrospinal fluid (CSF) leaks require advanced myelographic techniques for precise localization, which is in turn necessary for optimal treatment. Here, we will discuss the various myelographic techniques that have become available in recent years for CSF leak localization. Each of these can be used to detect many different types of spinal CSF leaks, although each modality has unique advantages and disadvantages, which will be outlined here.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewFluoroscopic, Computed Tomographic, and Magnetic Resonance Myelography.
Despite all the advantages of magnetic resonance (MR) imaging, there still exist contraindications or limitations to its use. Thus, MR imaging has not entirely replaced fluoroscopic or computed tomographic (CT) myelography to depict the outline of the spinal cord and its nerve roots after intrathecal injection of contrast medium. The growing recent interest of neuroradiologists to accurately diagnose and treat cerebrospinal fluid leaks has also driven a resurgent need for familiarity with this image-guided procedure. This article reviews the numerous technical and periprocedural aspects of fluoroscopic and CT myelography, and the use of noninvasive MR myelography in certain clinical scenarios.