Targeted repair of a refractory ventral cerebrospinal fluid leak identified by dynamic computed tomography myelography: illustrative case
Year: 2026
Type: article
Study design: Case Report
Abstract: BACKGROUND: Spontaneous spinal CSF leaks can be difficult to diagnose, particularly with large or multiple dural tears. Although conventional CT myelography (CTM) is the standard imaging modality, it may fail to localize elusive leaks. Dynamic CTM (dCTM) enables real-time contrast tracking and improves localization, particularly for type 1 (ventral dural tear) and type 2 (lateral dural tear) leaks, to support targeted intervention. OBSERVATIONS: A 36-year-old woman with Birt-Hogg-Dubé syndrome and recurrent spontaneous CSF leaks previously treated with multiple epidural blood patches presented with worsening positional headaches. Brain MRI demonstrated features of intracranial hypotension, and total spine MRI raised concern for extradural fluid collection. Conventional CTM demonstrated a ventral extradural collection extending between T4 and T11 without a definitive source. Dynamic CTM successfully localized a ventral dural defect at T10-11. The patient underwent a posterior T10-11 laminectomy with dural reinforcement via a transpedicular approach using a TachoSil patch with DuraSeal. Her headaches resolved immediately, and she remained asymptomatic at the 6-month follow-up. LESSONS: Dynamic CTM is a valuable tool for localizing ventral and lateral spinal CSF leaks when standard imaging is inconclusive. Early application of dCTM may reduce unnecessary interventions, shorten treatment delays, and optimize surgical planning. https://thejns.org/doi/10.3171/CASE25700.
DOI: 10.3171/case25700
Institution: University of Pittsburgh Medical Center
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7140212378
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