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The purpose of this video is to introduce digital subtraction myelography for CSF-venous fistula (CVF) detectection. CVF is the most recently identified and likely the most prevalent type of spinal CSF leak that leads to spontaneous intracranial hypotension CVFs are occult on conventional MRI and CT, necessitating the use of myelography for the diagnosis. This video highlights one such technique, which is important because an increasing number of centers are starting to diagnose CVF.

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Role of CT myelography in the diagnosis and management of spontaneous intracranial hypotension.

Clin Neurol Neurosurg

December 2024

CHU de Lille, 2 Avenue Oscar Lambret, Hauts-de-France, France. Electronic address:

Introduction: Spontaneous intracranial hypotension (SIH) is a secondary cause of headache. Its pathophysiology is complex, and relies mainly on the notion of a localized leak, and thus a loss of cerebrospinal fluid (CSF) in the spinal region. SIH is little known to the medical profession, for which CT myelography is a technique on the rise, allowing to identify and treat the leak using a blood-patch or a fibrin sealant.

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Background: The majority of patients with spontaneous intracranial hypotension (SIH) are symptomatic. Some patients are discovered incidentally. The proportion of asymptomatic SIH has never been defined.

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Objective: The aim of this study was to ascertain whether patient age was a significant factor for the accurate identification of compressive intervertebral disc extrusions (IVDE) in Dachshunds using non-contrast computed tomography (CT).

Methods: This retrospective analysis encompassed 150 Dachshunds evaluated for suspected IVDE at a referral hospital in south-eastern Queensland, Australia. Each case underwent diagnostic evaluation by CT, either with or without myelography, or magnetic resonance imaging (MRI), followed by surgical intervention for an intervertebral disc extrusion.

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Cerebrospinal Fluid Leaks: Diagnosis, Management, and Outcomes.

Neurosurg Clin N Am

January 2025

Department of Radiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045, USA.

Cerebrospinal fluid (CSF) leaks are a challenging condition characterized by the loss of CSF, leading to severe orthostatic headaches and other debilitating symptoms. Diagnosis and management require a multifaceted approach involving clinical evaluation, imaging, and various treatment modalities to improve patient outcomes and quality of life.

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