• Hiroya Fujimaki, Nobuhito Saito, Masahiko Tosaka, Yukitaka Tanaka, Keishi Horiguchi, and Tomio Sasaki.
• Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Gunma, Japan.
• Surg Neurol. 2002 Sep 1; 58 (3-4): 280-4; discussion 284-5.

BackgroundPrecise determination of the spinal level of a cerebrospinal fluid leak is important in the diagnosis and treatment of spontaneous intracranial hypotension. The authors report two cases of SIH in which a cerebrospinal fluid leak was demonstrated by three-dimensional computed tomographic (3D-CT) myelography.Case DescriptionBy overlaying 3D-CT images of contrast-enhanced CSF and the spine, the point of leakage was clearly depicted in the three-dimensional spinal structure, which assisted targeted epidural blood patch under the guidance of fluoroscopy. Although associated chronic subdural hematoma had to be treated by burr hole drainage, the patients' postural headaches subsided after treatment.ConclusionClear CSF images in relation to vertebral bones are obtainable with 3D-CT myelography, rendering this modality very useful for the diagnosis and treatment of spontaneous intracranial hypotension.

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