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. 2024 Feb 21;49(4):293–297. doi: 10.1136/rapm-2023-105197

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© American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Lumbar imaging confirming persistent ventral cerebrospinal fluid leak. (A and B) Midline sagittal (A) and axial (B, lumbar L3 level) T2-weighted fat suppressed MRIs. Black arrows show ventral dura (A and B). White arrow shows ventral epidural fluid collection (B). (C–E) Prone digital subtraction myelogram: (C) lateral image of lumbar spine with patient prone on cath lab table showing needle placement and demonstrating site of contrast injection. (D) Early postcontrast injection images show pooling of unmixed intrathecal contrast along the ventral dura (black arrows) and ventral extravasation of contrast (gray arrow) at L3. (E) Seconds-delayed postcontrast injection image shows further spread of ventral epidural contrast extending from the ventral dural defect (gray arrow).