PMC10198209_01
MRI of the brain. (a) T1 in the sagittal projection, such signs of intracranial hypotension are visualized as an increase in the pituitary gland (red arrows), expansion of the sinus cavities of the DM (green arrows); (b) T1 with contrast enhancement in the sagittal projection, pachymeningeal accumulation of the contrast agent (blue arrows), enlarge pituitary gland (red arrow); (c) T2 in the axial projection, bilateral subdural hygromas (yellow arrows); (d) T1 with contrast enhancement in the coronal projection, with pachymeningeal accumulation of the contrast agent (blue arrows), enlarge pituitary gland (red arrow). MRI: Magnetic resonance imaging, DM: Dura mater
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F1
MRI of the spine. (a) MR myelography of the cervical spine T2-WI in the sagittal projection, the red arrow indicates the DM, the white arrow indicates the presence of intra- and extradural CSF; (b) T2-WI of the cervical spine in the sagittal projection, the red arrow indicates the DM, the white arrow indicates the presence of intra- and extradural CSF; (c) MR myelography of the cervical spine in the sagittal projection, the outflow of CSF is determined extravertebral (white arrow). MRI: Magnetic resonance imaging, DM: Dura mater, CSF: Cerebrospinal fluid, T2-WI: T2-weighted image
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F2
CT myelography and CT of the spine without contrast. (a and b) CT myelography in axial and sagittal projections (a and c), in area of Th3-4 vertebrae, extradural spread of a contrast agent is detected (red contour); (b and d) CT scan of the spine 14 h after CT myelography without contrast, a small osteophyte was detected near the Th3-4 vertebrae (blue outline). CT: Computed tomography
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F3
To pinpoint the location of the dural fistula during hospitalization, computed tomography (CT) myelography was performed [Figure 3].
Intraoperative photos. (a) on the ventral surface of the DM, after retraction of the spinal cord, an ossified formation (blue outline) perforating the DM is visualized; (b) final stage of removal of the formation, the defect of the dura mater is better visualized (green contour); (c) fully visualized linear defect of the dura mater; (d) the defect of the dura mater is sutured. DM: Dura mater
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F4
A small, ossified formation was found at the base of a linear DM defect up to 10 mm in size was found [Figure 4].
Postoperative MRI of the brain. (a and c) T1-WI with contrast enhancement in the sagittal and coronal projections on day 3 after surgery; (b and d) T1-WI with contrast enhancement in the sagittal and coronal projection 4 months after surgery. On the 3rd day after the operation, in Figures a and b, signs of regression of intracranial hypotension are determined: a decrease in the intensity of accumulation of the contrast agent TMT, a slight decrease in the pituitary gland. Bilateral subdural hematomas persist in the acute-subacute stage. Four months after the operation, in addition to the above-mentioned signs, regression of subdural hematomas was noted. MRI: Magnetic resonance imaging, T1-WI: T1-weighted image
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F5
The postoperative period proceeded satisfactorily, with histological examination: "Cartilage tissue with dystrophic changes." The patient was discharged on day 3 after the surgery when these complaints regressed completely, and according to the MRI of the brain, there were signs of regression of intracranial hypotension [Figure 5]. The control MRI shows a positive trend, with no signs of intracranial hypotension and the absence of subdural accumulations [Figure 5].