T2反転画像が髄液漏出点の描出に有用であった脳脊髄液漏出症の1例
脳脊髄液漏出症は諸検査を施行しても硬膜破綻部位の同定が困難である場合が少なくない. 治療方針決定のためにも硬膜破綻部位の同定に特異度の高い検出法が必要である. 今回, T2*反転画像で硬膜外髄液漏出がくも膜下腔と連続する所見が得られ, 硬膜破綻部位を推定できた. これは腰椎穿刺手技や薬剤が不要で, 単時間かつ非侵襲的に施行可能な単純MRI検査である. さらに硬膜修復の程度までも把握でき, 治療のみならず治療効果判定にも有用であった....
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| Published in | 脳神経外科ジャーナル Vol. 23; no. 6; pp. 504 - 509 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.23.504 |
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| Abstract | 脳脊髄液漏出症は諸検査を施行しても硬膜破綻部位の同定が困難である場合が少なくない. 治療方針決定のためにも硬膜破綻部位の同定に特異度の高い検出法が必要である. 今回, T2*反転画像で硬膜外髄液漏出がくも膜下腔と連続する所見が得られ, 硬膜破綻部位を推定できた. これは腰椎穿刺手技や薬剤が不要で, 単時間かつ非侵襲的に施行可能な単純MRI検査である. さらに硬膜修復の程度までも把握でき, 治療のみならず治療効果判定にも有用であった. |
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| AbstractList | 脳脊髄液漏出症は諸検査を施行しても硬膜破綻部位の同定が困難である場合が少なくない. 治療方針決定のためにも硬膜破綻部位の同定に特異度の高い検出法が必要である. 今回, T2*反転画像で硬膜外髄液漏出がくも膜下腔と連続する所見が得られ, 硬膜破綻部位を推定できた. これは腰椎穿刺手技や薬剤が不要で, 単時間かつ非侵襲的に施行可能な単純MRI検査である. さらに硬膜修復の程度までも把握でき, 治療のみならず治療効果判定にも有用であった. |
| Author | 三木, 潤一郎 山家, 弘雄 林, 宣秀 中尾, 直之 仲, 寛 今栄, 信治 |
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| References | 4) Carstensen M, Chaudhary N, Leung A, Ng W : Supine digital subtraction myelography for the demonstration of a dorsal cerebrospinal fluid leak in a patient with spontaneous intracranial hypotension : a technical note. J Radiol Case Rep 6 : 1-9, 2012. 17) Schick U, Musahl C, Papke K : Diagnostics and treatment of spontaneous intracranial hypotension. Minim Invasive Neurosurg 53 : 15-20, 2010. 3) Bonetto N, Manara R, Citton V, Cagnin A : Spinal subtraction MRI for diagnosis of epidural leakage in SIH. Neurology 77 : 1873-1876, 2011. 14) Luetmer PH, Mokri B : Dynamic CT myelography : a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol 24 : 1711-1714, 2003. 13) Katramados A, Patel SC, Mitsias PD : Non-invasive magnetic resonance myelography in spontaneous intracranial hypotension. Cephalalgia 26 : 1160-1164, 2006. 19) Sencakova D, Mokri B, McClelland RL : The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57 : 1921-1923, 2001. 6) Fujimaki H, Saito N, Tosaka M, Tanaka Y, Horiguchi K, Sasaki T : Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with spontaneous intracranial hypotension. Surg Neurol 58 : 280-285, 2002. 2) Beards SC, Jackson A, Griffiths AG, Horsman EL : Magnetic resonance imaging of extradural blood patches : appearances from 30 min to 18 h. Br J Anaesth 71 : 182-188, 1993. 20) Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG : Clinical experiences with spontaneous intracranial hypotension : a proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg 113 : 373-379, 2011. 12) Kantor D, Silberstein SD : Cervical epidural blood patch for low CSF pressure headaches. Neurology 65 : 1138, 2005. 8) Horikoshi T, Watanabe A, Uchida M, Kinouchi H : Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment. J Neurosurg 113 : 940-946, 2010. 18) Schievink WI : Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295 : 2286-2296, 2006. 10) Hsu HL, Chen CJ, Ro LS, Wang LJ, Wong YC : Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension. Chang Gung Med J 25 : 854-859, 2002. 1) Albayram S, Kilic F, Ozer H, Baghaki S, Kocer N, Islak C : Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome. AJNR Am J Neuoradiol 29 : 116-121, 2008. 15) 脳脊髄液減少症研究会ガイドライン作成委員会 : 脳脊髄液減少症ガイドライン2007. 東京, メディカルレビュー社, 2007. 5) Dillon WP, Fishman RA : Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 19 : 1001-1002, 1998. 16) 佐藤慎哉, 嘉山孝正 : 低髄液圧症候群, 脳脊髄液減少症, 脳脊髄液漏出症. 脳外誌 22 : 443-451, 2013. 11) Kamada M, Fujita Y, Ishii R, Endoh S : Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue. Headache 40 : 844-847, 2000. 7) Hattingen E, DuMesnil R, Pilatus U, Raabe A, Kahles T, Beck J : Contrast-enhanced MR myelography in spontaneous intracranial hypotension : description of an artefact imitating CSF leakage. Eur Radiol 19 : 1799-1808, 2009. 9) Hoxworth JM, Trentman TL, Kotsenas AL, Thielen KR, Nelson KD, Dodick DW : The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol 199 : 649-653, 2012. |
| References_xml | – reference: 2) Beards SC, Jackson A, Griffiths AG, Horsman EL : Magnetic resonance imaging of extradural blood patches : appearances from 30 min to 18 h. Br J Anaesth 71 : 182-188, 1993. – reference: 12) Kantor D, Silberstein SD : Cervical epidural blood patch for low CSF pressure headaches. Neurology 65 : 1138, 2005. – reference: 16) 佐藤慎哉, 嘉山孝正 : 低髄液圧症候群, 脳脊髄液減少症, 脳脊髄液漏出症. 脳外誌 22 : 443-451, 2013. – reference: 7) Hattingen E, DuMesnil R, Pilatus U, Raabe A, Kahles T, Beck J : Contrast-enhanced MR myelography in spontaneous intracranial hypotension : description of an artefact imitating CSF leakage. Eur Radiol 19 : 1799-1808, 2009. – reference: 13) Katramados A, Patel SC, Mitsias PD : Non-invasive magnetic resonance myelography in spontaneous intracranial hypotension. Cephalalgia 26 : 1160-1164, 2006. – reference: 8) Horikoshi T, Watanabe A, Uchida M, Kinouchi H : Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment. J Neurosurg 113 : 940-946, 2010. – reference: 14) Luetmer PH, Mokri B : Dynamic CT myelography : a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol 24 : 1711-1714, 2003. – reference: 17) Schick U, Musahl C, Papke K : Diagnostics and treatment of spontaneous intracranial hypotension. Minim Invasive Neurosurg 53 : 15-20, 2010. – reference: 1) Albayram S, Kilic F, Ozer H, Baghaki S, Kocer N, Islak C : Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome. AJNR Am J Neuoradiol 29 : 116-121, 2008. – reference: 15) 脳脊髄液減少症研究会ガイドライン作成委員会 : 脳脊髄液減少症ガイドライン2007. 東京, メディカルレビュー社, 2007. – reference: 4) Carstensen M, Chaudhary N, Leung A, Ng W : Supine digital subtraction myelography for the demonstration of a dorsal cerebrospinal fluid leak in a patient with spontaneous intracranial hypotension : a technical note. J Radiol Case Rep 6 : 1-9, 2012. – reference: 11) Kamada M, Fujita Y, Ishii R, Endoh S : Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue. Headache 40 : 844-847, 2000. – reference: 6) Fujimaki H, Saito N, Tosaka M, Tanaka Y, Horiguchi K, Sasaki T : Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with spontaneous intracranial hypotension. Surg Neurol 58 : 280-285, 2002. – reference: 5) Dillon WP, Fishman RA : Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 19 : 1001-1002, 1998. – reference: 9) Hoxworth JM, Trentman TL, Kotsenas AL, Thielen KR, Nelson KD, Dodick DW : The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol 199 : 649-653, 2012. – reference: 10) Hsu HL, Chen CJ, Ro LS, Wang LJ, Wong YC : Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension. Chang Gung Med J 25 : 854-859, 2002. – reference: 3) Bonetto N, Manara R, Citton V, Cagnin A : Spinal subtraction MRI for diagnosis of epidural leakage in SIH. Neurology 77 : 1873-1876, 2011. – reference: 18) Schievink WI : Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295 : 2286-2296, 2006. – reference: 20) Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG : Clinical experiences with spontaneous intracranial hypotension : a proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg 113 : 373-379, 2011. – reference: 19) Sencakova D, Mokri B, McClelland RL : The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57 : 1921-1923, 2001. |
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| Snippet | 脳脊髄液漏出症は諸検査を施行しても硬膜破綻部位の同定が困難である場合が少なくない. 治療方針決定のためにも硬膜破綻部位の同定に特異度の高い検出法が必要である. 今... |
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| SubjectTerms | cerebrospinal fluid leak non-invasive T2 reverse imaging |
| Title | T2反転画像が髄液漏出点の描出に有用であった脳脊髄液漏出症の1例 |
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