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
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.