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Updated: Sep 28, 2026

Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with
Hiroya Fujimaki1, Nobuhito Saito, Masahiko Tosaka
1Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Gunma, Japan.
Background:
Precise determination of the spinal level of a cerebrospinal fluid leak is important in the diagnosis and treatment of spontaneous intracranial hypotension. The authors report two cases of SIH in which a cerebrospinal fluid leak was demonstrated by three-dimensional computed tomographic (3D-CT) myelography.
Case Description:
By overlaying 3D-CT images of contrast-enhanced CSF and the spine, the point of leakage was clearly depicted in the three-dimensional spinal structure, which assisted targeted epidural blood patch under the guidance of fluoroscopy. Although associated chronic subdural hematoma had to be treated by burr hole drainage, the patients' postural headaches subsided after treatment.
Conclusion:
Clear CSF images in relation to vertebral bones are obtainable with 3D-CT myelography, rendering this modality very useful for the diagnosis and treatment of spontaneous intracranial hypotension.
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