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
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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The cerebrospinal fluid spaces of the spine and brain are an intricate network of tissues with complex anatomic relationships. Understanding the normal imaging anatomy and variants of these spaces is crucial for accessing the spinal subarachnoid space and evaluating patients with suspected CSF leaks. This article reviews the imaging anatomy of the cerebrospinal fluid spaces in the spine and brain with emphasis on clinically relevant anatomy for percutaneous needle access to the spinal subarachnoid space and management of patients with CSF leak.
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Neuroimaging Clin. N. Am. · Feb 2025
ReviewIntrathecal Contrast-enhanced Computed Tomography and MR Cisternography for Skull Base Cerebrospinal Fluid Leaks and Other Intracranial Applications.
Acquired skull base cerebrospinal fluid (CSF) leaks can result from trauma, tumors, iatrogenic causes, or may be spontaneous. Spontaneous skull base CSF leaks are likely a manifestation of underlying idiopathic intracranial hypertension. ⋯ When leaks are multiple or if samples of fluid cannot be obtained for testing, then recourse to intrathecal contrast-enhanced cisternography may be necessary. We also review various other applications for diagnosis of intracranial abnormalities using contrast-enhanced cisternography.