Cone-Beam CT for the Detection of a Ventral Spinal CSF Leak in Spontaneous Intracranial Hypotension

A 36-year-old man had orthostatic headache and bilateral hygromas secondary to spontaneous intracranial hypotension (SIH). An epidural blood patch temporarily improved symptoms. Three weeks later, he presented with impaired consciousness and severe progress on MRI, which showed a new cerebellar tonsil herniation and increased hygromas (Figure 1, B and D). A ventral dural tear was missed on digital subtraction myelography (DSM) in prone position (Figure 2A) but was clearly demonstrated on subsequent cone-beam CT (CB-CT) by rotation of the C-arm within 3 seconds (Figure 2B). This technique has not been described previously to detect a ventral dural tear in patients with SIH. CB-CT provides cross-sectional images with high spatial resolution and can be performed immediately after DSM to confirm or exclude unclear findings.1 Multiphase CT-myelography is available as diagnostic alternative but usually requires high radiation dose.2 The leak was confirmed by surgery, and the patient recovered completely.