Article Figures & Data
Figures
- Fig 1.
Technique for CT-guided transforaminal blood patching. A, Needle placement before patching. The needle tip is located in the posterior third of the neural foramen, adjacent to a diverticulum of the nerve root (arrow). B, Contrast injected before blood patching confirms the location in the epidural space. C, Image obtained during injection of autologous blood demonstrates displacement of the contrast by the injected blood and mild mass effect on the diverticulum.
- Fig 2.
Resolution of imaging changes of intracranial hypotension. A, Pretreatment MR image shows typical signs of intracranial hypotension, including smooth dural thickening and enhancement (arrowheads) and subdural collections (arrows). B, Follow-up brain MR image after CT-guided targeted blood patching demonstrates resolution of dural enhancement and subdural collections.
- Fig 3.
Pre- and posttreatment MR imaging from patient 2. Dashed line indicates the foramen magnum. A, Pretreatment MR image demonstrates cerebellar tonsillar ectopia (arrow). The dashed line indicates the plane of the foramen magnum. Midline sagging of the brain with inferior displacement of the mammillary bodies is seen. In this patient, there was no abnormal dural enhancement on pretreatment MR imaging (not shown). B, Follow-up brain MR image after CT-guided blood patching demonstrates resolution of the cerebellar tonsillar ectopia and midline sag.
- Fig 4.
Pre- and posttreatment appearance of spinal fluid collections. A, Pretreatment CT myelogram from patient 6 demonstrates a subdural fluid collection (arrow) in the spinal canal, which narrows the CSF space. B, Follow-up CT myelogram 15 days after CT-guided blood patching at the site of leak demonstrates resolution of the subdural collection. C, Pretreatment CT myelogram from patient 3 demonstrates an extradural collection ventral to the thecal sac, extending into the nerve root sleeves (arrow). D, Follow-up CT myelogram 17 days after CT-guided blood patching of the nerve root sleeves demonstrates near-complete resolution of the collection.
- Fig 5.
Representative examples of targets for blood patching. A, CT myelogram demonstrates extravasation of contrast from a nerve root sleeve (white arrow) due to a high-flow leak. Note the presence of an extradural collection surrounding the thecal sac (black arrow). B, CT myelogram in a different patient demonstrates an enlarged diverticulum of the nerve root sleeve (arrowhead). Although no direct myelographic evidence of leak is seen, this site was chosen for empiric blood patching on the basis of the potential for an intermittent or low-flow leak.
Tables
Patient No. Opening Pressure (cm H20) Spinal Fluid Collection Irregular Diverticula Direct Visualization of Leak Location of Diverticula Cervical Upper Thoracic (T1–6) Lower Thoracic (T6–12) Lumbar 1 0 + + + 0 4 0 0 2 15 – + – 0 1 2 0 3 0 + – + 0 5 0 0 4 N/A – + – 0 0 7 0 5 N/A – + – 0 0 2 0 6 0 + + + 0 0 1 0 7 0 – + – 0 2 5 1 8 12 – + – 0 1 4 5 Note: a + indicates presence of the finding; –, absence of the finding.
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