PMC7827517_01
Preoperative imaging studies. (a) Magnetic resonance imaging neural axis demonstrating intracranial hypotension with no evidence of caudal tethered cord and contrast enhancement of T8 and T9 vertebral bodies. (b) Computed tomography thoracic spine demonstrating osseous lytic changes from T7 to T10 involving L T7-8 and T8-9 facet.
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F1
A CT brain demonstrated 1.5 cm cerebellar tonsillar ectopia, while the MR showed intracranial hypotension [Figure 1].
Preoperative imaging study. (a) Sagittal T1 post contrast. (b) Axial T2 myelography. (c) Sagittal T2 magnetic resonance imaging demonstrating contrast enhancement of T8 and T9 vertebral bodies and extravasation of cerebrospinal fluid ventrally into pleural space.
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F2
The thoracic magnetic resonance imaging revealed a CSF leak and signal change within the T7-10 vertebral bodies [Figure 2].
Postoperative X-ray thoracic spine demonstrating successful placement of instrumentation from T6 to T11.
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F3
T6 to T11, but only unilaterally at T8-9 given the lack of bony fixation points [Figure 3]. The postoperative course was uneventful; the headaches and back pain resolved, and she was discharged home on postoperative day 4.
(a) Variably sized cystic hemorrhagic spaces have entirely replaced the intertrabecular marrow and connective tissue elements (H and E, low power). (b) The hemorrhagic cystic spaces are lined by flattened unremarkable endothelium (H and E, intermediate power). (c) Areas of fibrosis and reactive bone, with osteoblastic rimming, accompany the hemorrhagic cystic spaces, lined by flattened unremarkable endothelium (H and E, intermediate power).
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F4
Postoperative imaging study. Axial T2 magnetic resonance imaging demonstrating pleural effusion, suggestive of persistent cerebrospinal fluid leak.
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F5
Her positional headaches persisted, and imaging demonstrated a subtle persistent CSF leak which was treated with a blood patch [Figure 5].