Neuroimaging clinics of North America
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Dural puncture, commonly referred to as lumbar puncture (LP), carries the risk of rare but serious complications including post-dural puncture headache, hemorrhage, herniation, and infection. These complications can lead to suboptimal patient outcomes including significant morbidity and mortality in some instances. This review comprehensively examines potential LP complications, including their incidence, pathophysiology, risk factors, clinical presentations, imaging findings, preventative measures, and treatment strategies. Familiarity with these complications will equip clinicians to effectively manage these complications through prompt recognition, timely diagnosis, and implementation of appropriate preventative measures.
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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.
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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
ReviewStandard Fluoroscopic and Computed Tomography-Guided Lumbar Punctures.
Image-guided lumbar puncture (LP) remains an important part of the modern practice of neuroradiology. This review outlines the relevant anatomy, safety considerations, and techniques in performing fluoroscopic and computed tomography-guided LPs.
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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.