CT myelography has been traditionally used to evaluate post-operative paraspinal fluid collections to discern CSF leaking into a pseudomeningocele versus a contained seroma. Rather than performing a lumbar puncture and injecting intrathecal contrast for myelography, we present the first report of direct contrast injection into a post-operative paraspinal pseudomeningocele for CSF leak confirmation and localization. This is a simple procedure that has several advantages over a conventional CT myelogram for the evaluation of post-operative paraspinal fluid collections.
MalhotraAKalraVBWuX, et al.Imaging of lumbar spinal surgery complications. Insights Imaging2015; 6: 579–590. DOI: 10.1007/s13244-015-0435-8.
2.
LeeKSHardyIM. Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery1992; 30: 111–114. DOI: 10.1227/00006123-199201000-00020.
3.
TeplickJGPeysterRGTeplickSK, et al.CT Identification of postlaminectomy pseudomeningocele. AJR Am J Roentgenol1983; 140(6): 1203–1206. DOI: 10.2214/ajr.140.6.1203.
4.
GhodasaraNYiPHClarkK, et al.Postoperative spinal CT: what the radiologist needs to know. Radiographics2019; 39(6): 1840–1861. DOI: 10.1148/rg.2019190050.
5.
OppelFSchrammJSchirmerM, et al.Results and complicated course after surgery for lumbar disc herniation. Berlin, Heidelberg: Springer Berlin Heidelberg, in Lumbar Disc Adult Hydrocephalus, 1977, pp. 36–51.
6.
TafazalSISellPJ. Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J2005; 14(3): 287–290. DOI: 10.1007/s00586-004-0821-2.
7.
MarkITMadhavanAABensonJC, et al. Updated ultrafast dynamic computed tomography myelography technique for cerebrospinal fluid leaks. Interv Neuroradiol. 2023. DOI: 10.1177/15910199231193463.
8.
NasceneDROzutemizCEstbyH, et al.Transforaminal lumbar puncture: an alternative technique in patients with challenging access. AJNR Am J Neuroradiol2018; 39(5): 986–991. DOI: 10.3174/ajnr.A5596.
9.
DanielsSPSchweitzerADBaidyaR, et al.The Lateral C1-C2 puncture: Indications, technique, and Potential complications. AJR Am J Roentgenol2019; 212: 431–442. DOI: 10.2214/ajr.18.19584.
10.
PhilipJTFloresMABeegleRD, et al.Rates of epidural blood patch following lumbar puncture comparing atraumatic versus Bevel-Tip needles stratified for body mass index. AJNR Am J Neuroradiol2022; 43(2): 315–318. DOI: 10.3174/ajnr.A7397.
11.
MarkITDillonWPRichieMB, et al.MRI findings after recent image-guided lumbar puncture: the rate of dural enhancement and subdural collections. AJNR Am J Neuroradiol2022; 43(5): 784–788. DOI: 10.3174/ajnr.A7496.
