Spinal fluid-venous fistula: a mechanism for intravascular Pantopaque infusion during myelography

1974 ◽  
Vol 41 (6) ◽  
pp. 773-776 ◽  
Author(s):  
Paul M. Lin ◽  
Joseph Clarke
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Intracranial Hypotension ◽  
Spinal Fluid ◽  
Venous Plexus ◽  
Content Type ◽  
Venous Fistula ◽  
Fine Print

✓ Two cases of intravascular infusion of Pantopaque occurring during myelography are reported. Cerebrospinal fluid-venous fistula is described as the mechanism of escape of Pantopaque from the subarachnoid space into a venous plexus and as a possible explanation of postspinal intracranial hypotension.

Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor

1976 ◽  
Vol 45 (1) ◽  
pp. 104-107 ◽  
Author(s):  
Colin R. Bamford ◽  
Enrique L. Labadie
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Plasma Proteins ◽  
Cauda Equina ◽  
Spinal Fluid ◽  
Clinical Settings ◽  
Content Type ◽  
Fluid Reabsorption ◽  
Elevated Protein ◽  
Fine Print

✓ An elderly man presented with signs of normotensive hydrocephalus. Elevated protein content in the spinal fluid led to the diagnosis of an “asymptomatic” cauda equina neurilemoma and its removal. Within 6 weeks the patient's mental status had dramatically improved. Chronic transudation of plasma proteins including fibrinogen into the subarachnoid space had probably impeded spinal fluid reabsorption. It is suggested that the leakage of fibrinogen into the cerebrospinal fluid may be the cause of hydrocephalus in other clinical settings in which there is an elevation of the spinal fluid protein.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

The empty sella and some related syndromes

1972 ◽  
Vol 36 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Sixto Obrador
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Pituitary Glands ◽  
Diaphragma Sellae ◽  
Fine Print ◽  
Syndrome Association

✓ A case of empty sella syndrome due to a benign intrasellar cyst leads the author to a review of variations in this syndrome. Association with intrasellar diverticuli of the subarachnoid space, deficiencies of the diaphragma sellae, and small pituitary glands are identified. Its relationship with certain headaches in women and to unexplained nontraumatic cerebrospinal fluid rhinorrhea are discussed.

The effects of raised ICP on lymph flow in the cervical lymphatic trunks in cats

1984 ◽  
Vol 60 (3) ◽  
pp. 577-581 ◽  
Author(s):  
James A. Love ◽  
Ronald A. Leslie
Keyword(s):  
Cerebrospinal Fluid ◽  
Steady State ◽  
Subarachnoid Space ◽  
Lymphatic System ◽  
Cranial Nerves ◽  
Lymph Flow ◽  
Content Type ◽  
Large Molecules ◽  
Csf Pressure ◽  
Fine Print

✓ Lymph was collected from cervical lymphatic trunks of anesthetized cats under conditions of normal cerebrospinal fluid (CSF) pressure and again when the CSF pressure was elevated by infusing artificial CSF into the subarachnoid space at the cisterna magna. There was an immediate increase in lymph flow on initiation of the CSF infusion, but this increase was not maintained although the CSF infusion continued. Lymph protein concentrations fell when the CSF infusion started and remained depressed while the infusion of CSF continued. It is postulated that under steady-state conditions much of the CSF leaving the subarachnoid space via the cranial nerves enters the capillaries from the extravascular spaces, and that large molecules from the CSF, such as proteins, return to the blood via the lymphatic system.

The effect of dexamethasone phosphate on the production rate of cerebrospinal fluid in the spinal subarachnoid space of dogs

1973 ◽  
Vol 39 (4) ◽  
pp. 480-484 ◽  
Author(s):  
Osamu Sato ◽  
Makoto Hara ◽  
Takehiko Asai ◽  
Ryuichi Tsugane ◽  
Naoki Kageyama
Keyword(s):  
Cerebrospinal Fluid ◽  
Production Rate ◽  
Subarachnoid Space ◽  
Content Type ◽  
Spinal Subarachnoid Space ◽  
Dexamethasone Phosphate ◽  
Maximal Reduction ◽  
Csf Production ◽  
Fine Print

✓ The effect of intravenous dexamethasone on cerebrospinal fluid (CSF) production was studied in dogs by a method of caudocephalad perfusion of the spinal subarachnoid space with an inulin-containing buffer. The CSF production rate began to reduce immediately after the injection of 0.15 mg/kg and attained a maximal reduction of 50% in 50 minutes.

Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study

2003 ◽  
Vol 99 (5) ◽  
pp. 840-842 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Mary Riedinger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Surgical Repair ◽  
Csf Leak ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Mean ◽  
A Prospective Study ◽  
Fine Print

Object. Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak. Methods. The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22–55 years). The mean duration of follow up was 36 months (range 6–132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients. Conclusions. Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.

Noninvasive optical imaging of the subarachnoid space and cerebrospinal fluid pathways based on near-infrared fluorescence

1997 ◽  
Vol 87 (5) ◽  
pp. 738-745 ◽  
Author(s):  
Kaoru Sakatani ◽  
Masaki Kashiwasake-Jibu ◽  
Yoshinori Taka ◽  
Shijie Wang ◽  
Huancong Zuo ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Injection Site ◽  
Fluorescence Imaging ◽  
Subarachnoid Space ◽  
Near Infrared ◽  
Content Type ◽  
Spinal Subarachnoid Space ◽  
Lumbar Spinal ◽  
Fine Print

✓ The authors have developed a noninvasive optical method to image the subarachnoid space and cerebrospinal fluid pathways in vivo based on the near-infrared fluorescence of indocyanine green (ICG). The ICG was bound to purified lipoproteins (ICG—lipoprotein) and injected into the subarachnoid space of neonatal and adult rats. The ICG fluorescence was detected by a cooled charge-coupled device camera. After injection of ICG—lipoprotein into the cerebral subarachnoid space of the neonatal rat, ICG fluorescence was clearly detected at the injection site through the skull and skin. The ICG fluorescence was observed in the cerebellum and the lumbar spinal cord 1 and 8 hours postinjection, respectively. After injection of ICG—lipoprotein into the lumbar spinal subarachnoid space of an adult rat, ICG fluorescence was observed from the injection site to the thoracic levels along the spinal subarachnoid space. In addition, with the rat's head tilted downward, ICG fluorescence had extended to the cerebral subarachnoid space by 1 hour postinjection. The ICG fluorescence imaging of the cerebral subarachnoid space demonstrated an increase in fluorescence intensity around the lambdoid suture and the forebrain. On dissection of the rat brain the former location was identified as the supracerebellar cistern and the latter as the olfactory cistern. The results of this study are the first to demonstrate that an optical technique is applicable to imaging of the subarachnoid space and cerebrospinal fluid pathways in vivo. In addition, ICG—lipoprotein provides a sensitive optical tracer for imaging extravascular biological structures. Finally, ICG fluorescence imaging does not require an intricate imaging system because ICG is localized near the surface of the body.

Cerebrospinal fluid may nourish cerebral vessels through pathways in the adventitia that may be analogous to systemic vasa vasorum

1982 ◽  
Vol 56 (4) ◽  
pp. 475-481 ◽  
Author(s):  
Nicholas T. Zervas ◽  
Theodore M. Liszczak ◽  
Marc R. Mayberg ◽  
Peter McL. Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Vessels ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Cerebral Vessels ◽  
Vasa Vasorum ◽  
Cerebral Blood Vessels ◽  
Content Type ◽  
Large Proteins ◽  
Fine Print

✓ Cerebral blood vessels are devoid of vasa vasorum. Therefore, the authors have studied the microarchitecture of the adventitia of large feline cerebral vessels and systemic vessels of the same size, in an effort to determine how the vessels are nourished. The cerebral vessels contain a rete vasorum in the adventitia that is permeable to large proteins and is in continuity with the subarachnoid space. This substructure may be analogous to the systemic vasa vasorum and may contribute to the nutrition of the cerebral arteries.

Spinal subarachnoid metastatic spread from non-neuraxial primary neoplasms

1979 ◽  
Vol 51 (2) ◽  
pp. 251-253 ◽  
Author(s):  
Charles G. H. West
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Subarachnoid Space ◽  
Rare Case ◽  
Content Type ◽  
Spinal Subarachnoid Space ◽  
The Central Nervous System ◽  
Primary Neoplasms ◽  
Fine Print

✓ A rare case of metastasis to the spinal subarachnoid space from a non-neuraxial primary tumor is presented. Dissemination was shown by computerized tomography to be via the cerebrospinal fluid from secondary deposits in the central nervous system and meninges. This route would seem to be the most common mode of spread to the spinal subarachnoid space.

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