Intradural Spinal Vein Enlargement in Craniospinal Hypotension
M. Todd Burtisa,
John L. Ulmera,
Glenn A. Millerb,
Alexandru C. Barbolic,
Scott A. Kossa and
W. Douglas Browna,b,c
a Division of Neuroradiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
b Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
c Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
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FIG 1. Cervicothoracic epidural pseudomeningocele with dilated cervical epidural venous plexus and spinal dural enhancement.
A, Contrast-enhanced axial CT scan demonstrates dilated cervical epidural venous plexus (black arrows), an epidural fluid collection (black arrowheads), and spinal dural enhancement (long arrows).
B, Sagittal reformatted CT images of the cervical spine demonstrates further the epidural fluid collection (black arrowheads) and dural enhancement.
C, Sagittal T2-weighted MR image of the cervical spine shows the epidural fluid collection (thin white arrows) and a cervicothoracic posterior dural margin (thick white arrows).
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FIG 2. Large epidural pseudomeningocele and dilated posterior thoracic spinal vein. Axial CT myelogram of the cervical and thoracic spine shows dura marginating the epidural pseudomeningocele (highlighted black arrows). Coronal and sagittal reformatted CT myelogram images of the thoracic spine demonstrate a tortuous, dilated posterior thoracic spinal vein (black arrows) and dura (arrowheads) separating intradural and epidural CSF.
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FIG 3. Large epidural pseudomeningocele. Axial CT myelogram of the midthoracic spine demonstrates an epidural pseudomeningocele extending into the neural foramina, outlining thoracic nerve roots (e.g., black arrows). Note faint opacification of the compressed subarachnoid space (black arrowhead) surrounding the cord (dotted outline), best seen at bottom right image.
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FIG 4. Illustration of intradural-extradural venous anastomosis. Daniels after Netter.
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