Journal of Pediatric Neurology 2011; 09(03): 373-377
DOI: 10.3233/JPN-2011-0488
Georg Thieme Verlag KG Stuttgart – New York

Radionuclide tagged blood cell patch to monitor spine coverage for spontaneous diffuse CSF leaks

David Q. Wan
a   Department of Diagnostic and Interventional Imaging, School of Medicine at Houston, University of Texas, Houston, TX, USA
,
Michael L. Pearlman
b   Division of Pediatric Neurology, School of Medicine at Houston, University of Texas, Houston, TX, USA
,
Bruce J. Barron
c   Emory University Hospital Midtown, Atlanta, GA, USA
,
Emilio P. Supsupin
a   Department of Diagnostic and Interventional Imaging, School of Medicine at Houston, University of Texas, Houston, TX, USA
,
Leo Hochhauser
a   Department of Diagnostic and Interventional Imaging, School of Medicine at Houston, University of Texas, Houston, TX, USA
› Author Affiliations

Subject Editor:
Further Information

Publication History

26 August 2009

12 June 2010

Publication Date:
30 July 2015 (online)

Abstract

We present a 14-year-old female patient with a 2 yr history of positional headache secondary to spontaneous diffuse cerebrospinal fluid (CSF) leaks. We treated the leak with an epidural blood patch which was radioactively labeled by a well-established nuclear medicine technique. Because spontaneous CSF leaks were frequently multifocal or diffuse throughout the spine, the extent of coverage or distribution of an epidural patch was generally determined by best estimate. Traditional radiographic contrast media mixed with the blood cells had been used to monitor the patch coverage and it is questionable whether the contrast can be representative of the cell distribution. We applied a nuclear medicine technique to label the autologous red blood cells to monitor the range of spinal cord coverage of each epidural patch. After two visible epidural patches covered both the lumbar and thoracic spine, computed tomography myelogram demonstrated significantly decreased leakage when compared to the pre-patch images. However, the patient’s symptoms remained essentially unchanged in the long term, which is consistent with refractory spontaneous CSF leaks. We believe that this sophisticated nuclear medicine blood labeling technique is a simple and accurate way to monitor the true cell coverage of the spine and the pattern of distribution.