Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewImage-guided Epidural Blood Patching and Fibrin Glue Occlusion of Cerebrospinal Fluid Leaks and Venous Fistulas.
There have been major advances in the diagnosis and treatment of spontaneous intracranial hypotension (SIH). While once thought to be a rare condition, the occurrence is not uncommon if diagnosed adequately. Our greater understanding of SIH is based on three main points: (1) awareness of the various types of spontaneous spinal cerebrospinal fluid (CSF) leaks; (2) advanced myelography with the precision to detect dural tears and CSF-venous fistulas; and (3) updated treatment techniques of epidural patching, embolization, and surgery. This review discusses the various types of epidural patching for CSF leaks.
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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.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewLumbar Transforaminal Injections of Nusinersen in Spinal Muscular Atrophy Patients.
Following a review of spinal muscular atrophy pathogenesis and current therapeutics, a comprehensive review of transforaminal lumbar injections is provided. Patient preparation, special considerations, procedural technique, complications, and alternative approaches are discussed.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewAlternative Percutaneous Dural Puncture Routes: Cervical, Thoracic, Lumbar, and Sacral.
Patients requiring lumbar punctures (LPs) are frequently challenging or may be impossible to do through a standard lower lumbar route. Therefore, if clinically indicated, consideration of alternative anatomic access routes to the spinal subarachnoid space may be necessary. However, some of these approaches are unpopular or seldom used, may be challenging to perform, or are associated with potential significant complications especially when combined with limited operator experience. Here we review the techniques and drawbacks of multiple different approaches for percutaneous insertion of spinal needles into the spinal dural sac as alternatives to standard interlaminar low LPs.
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Dural puncture, commonly referred to as lumbar puncture (LP), carries the risk of rare but serious complications including post-dural puncture headache, hemorrhage, herniation, and infection. These complications can lead to suboptimal patient outcomes including significant morbidity and mortality in some instances. This review comprehensively examines potential LP complications, including their incidence, pathophysiology, risk factors, clinical presentations, imaging findings, preventative measures, and treatment strategies. Familiarity with these complications will equip clinicians to effectively manage these complications through prompt recognition, timely diagnosis, and implementation of appropriate preventative measures.