Apport de la cisternographie isotopique dans la recherche de fuite du liquide céphalorachidien

Abstract

Introduction

Intracranial hypotension, primarily characterized by orthostatic headaches, is caused by cerebrospinal fluid (CSF) leakage in almost all cases. Although clinical symptoms can sometimes go unnoticed due to their fluctuating and subjective nature, CSF leakage can cause significant morbidity and potentially lead to irreversible disability. The aim of our study was to evaluate the diagnostic efficacy of radionuclide cisternography in patients presenting with signs of intracranial hypotension where cerebrospinal MRI did not identify the area of leakage.

Materials and methods

This was a retrospective, descriptive, monocentric study involving 35 patients. A standardized 2-day acquisition protocol was used for radionuclide cisternography following intrathecal injection of ¹¹¹In-DTPA via suboccipital or lumbar puncture.

Results

All 35 patients showed indirect signs of CSF leakage on radionuclide cisternography, compared to 71.4% on MRI. In 15 patients (42.8%), the site of the CSF leak was localized: 1 in the ethmoid bone, 2 adjacent to an osteosynthesis screw, and the remaining 12 at the cervicothoracic junction. These 15 patients received appropriate treatment, resulting in significant clinical improvement: 5 through microsurgery, 2 via injection of biological glue, and 8 with a targeted epidural blood patch.

Conclusion

This study demonstrates that radionuclide cisternography, although a technique developed around fifty years ago, remains relevant today as it can localize the site of a CSF leak not identified by conventional MRI, whether in cases of post-traumatic, post-surgical, or spontaneous leaks. The development of new radiotracers for PET is expected to further enhance detection sensitivity by improving spatial resolution.