PMC6744724_01
(a) Contrast-enhanced coronal magnetic resonance image showing minimal thickness and contrast enhancing in the bilateral dura. (b) Spinal T2-weighted magnetic resonance image showed the fluid collection in the posterior cervicothoracic level. (c) Myelography with computed tomography (myelography) showed double ring sign at the cervicothoracic junction. (d) Radioisotope cisternography 1 h after injection of tracer revealed apparent leakage of tracer from cervicothoracic junction.
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F1
The CT myelogram revealed a CSF leak at C7-T1 level [Figures 1 and 2].
Patient was placed in prone position between the arms of cone-beam computed tomography machine.
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F2
The CT myelogram revealed a CSF leak at C7-T1 level [Figures 1 and 2].
Costal, blade bones, bulky soft tissue, and air around the thin neck disturb correct interpretation of position of epidural needle under radiographic observation.
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F3
The distance from the entry point on the skin to the spinolaminar line was measured and the epidural needle was advanced up to 10 mm behind the spinolaminar line [Figures 3 and 4].
Cone-beam computed tomography scanning was done and the distance (a) from the entry point on the skin to the spinolaminar line (b) was measured on the sagittal reconstruction image.
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F4
The distance from the entry point on the skin to the spinolaminar line was measured and the epidural needle was advanced up to 10 mm behind the spinolaminar line [Figures 3 and 4].
Digital subtraction epidural imaging confirmed that the epidural needle was punctured correctly.
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F5
The needle position was then confirmed with biplane epidurography (i.e., documenting the spread of contrast dye evenly and symmetrically) [Figure 5].