神経外傷
Online ISSN : 2434-3900
原著
脳脊髄液漏出症診断の最前線
守山 英二
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ジャーナル フリー

2014 年 37 巻 1 号 p. 7-17

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Objective: The Cerebrospinal Fluid Hypovolemia Research Group beneficiary of a scientific research grant from the Ministry of Health, Labour and Welfare (MHLW) has con­cluded, that minor traumas, including motor vehicle accident, may cause spinal CSF leak. Because the first aim of MHLW research group was to confirm the occurrence of spinal CSF leak after minor trauma, very strict image diagnostic criteria were adopted. The purpose of this study is to weigh the MHLW criteria against the existing image diagnostics.

Materials and Methods: Between March 2011 and January 2013, 178 patients suspected with spinal CSF leak underwent combined radioisotope cisternography (RIC) and computed tomography myelography (CTM). Serial spinal MRIs were performed before and after combined RIC ⁄ CTM studies.

Results: RIC revealed overt RI leak in 47 patients (Group P), and CTM confirmed CSF leaks in 27 patients. In 52 patients with indirect RIC findings including early bladder filling and/or accelerated RI clearance (Group I), CTM confirmed CSF leaks in 7 patients. Eleven patients presented with typical clinical and radiological features of spontaneous intracranial hypotension (SIH) (Group P: 7, Group I: 4). Serial spinal MRI after combined RIC ⁄ CTM showed increased CSF leak in 33 ⁄ 47 patients (Group P), and 15 ⁄ 52 patients (Group I). In these patients, most CSF leaks were located at thoracolumbar junction.

Conclusion: This study shows spinal CSF leak is a complication of minor trauma. In the diagnosis of spinal CSF leak, RIC has several advantages in addition to its inherent ability, especially when combined with CTM. Combined RIC ⁄ CTM often increases CSF leak, resulting in the enhanced sensitivity of spinal MRI.

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© 2014 日本脳神経外傷学会
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