Neurnradiologv
Neuroradiology 17, 183-184 (1979)
© by Springer-Verlag 1979
Cervical Double Contrast Myelocisternography by the Lateral Approach (Technical Note) R. C. Schmidt Department of Neuroradiology, Medical School, Hannover, Germany
Summary. A simple method for the combined examination of the cervical spinal canal with Amipaque, and of the craniocervical junction with air, by one and the same puncture without changing the patient's position during the examination, is described. Key words: Contrast media - Cervical myelography - Craniocervical junction
raparesis with or without sensory disturbances or a circumscribed neurological level, if no reason is found for the symptomatology in the cervical spinal canal. This was well done by gas myelography, although a filling of the fourth ventricle is not always attained. This method Seems to be obsolete because of the much better visibility of the intrathecal structures obtained with the water-soluble contrast medium Amipaque [3, 4]. Double contrast myelocisternography by the lateral approach fills this need.
Introduction Method
There is a diagnostic gap in ~Jl positive contrast myelographies concerning the dorsal parts of the craniocervical junction. An examination of this region is especially wanted for cases of spastic tet-
Cervical myelography is performed by the lateral approach C1-2 on the Mimer III and rotating chair RTC-3 (Siemens-Elema) in the prone position
Fig. 1. Positioningof patient for cervical double contrastmyelocisternography, lateral tomography 0028-3940/79/0017/0183/$01.00
184
R.C. Schmidt: Cervical Double Contrast Myelocisternography
Fig. 2. Lateral xerotomogram with good visualization of spinal subarachnoid space, prepontine and cerebellomedullary cisterns, fourth ventricle, aqueduct and posterior third ventricle
(Fig. 1) as previously described [1]. We prefer to introduce the needle in the dorsal subarachnoid space. The outline of the spinal cord is thereby more homogeneous than with ventral puncture. The procedure is easier because the space dorsal to the spinal cord is wider, and the vertebral ax~tery cannot be damaged. We use 6-10 ml Amipaque with a concentration of 170 mg I/ml. If there is no pathological finding on myelography, we inject about 10 ml of air by the same route, without changing the position of the patient. The air fills the cerebellomedullary cistern, fourth ventricle, aqueduct, and posterior parts of the third ventricle. A small amount of Amipaque usually goes up or can easily be moved to the preponfine cistern. Lateral tomography is performed. The structures of the posterior fossa and the craniocervical junction are thus well outlined by positive and/or negative contrast (Fig. 2).
Discussion
We have prefered the lateral cervical approach since we started to use Amipaque for myelography in August 1975. Smaller amounts of the contrast medium are required, so there are fewer sequelae than after thoracic and cervical myelography by the lumbar route [4]. Visualization of the intraspinal structures is invariably excellent, but the diagnostic value of gas myelography is greater at the craniocervical junction. Skalpe [2] visualizes this region by
turning the patient form the prone to the supine position at the end of the examination. The amount of contrast medium that passes into the intracranial spaces is thus not to be estimated. We have tried to combine the advantages of both positive and negative contrast media without the disadvantages of greater discomfort and the frequency of side effects with higher doses of both media, and have eliminated turning the patient. This method is easy to perform, gives good visualization of the structures to be seen, and lowers the risk and discomfort of the examination.
References 1. Schmidt, R. C.: Die zervikale und thorakale Myelographie mit dern neuen wasserl6slichen Kontrastmittel Metrizamide (Amipaque). Akt. Neurol. 5, 97-104 (1978) 2. Skalpe, I. O.: Zervikale Myelographie rnit Metrizamid (Amipaque). Akt. Neurol. 4, 189-193 (1977) 3. Skalpe, I, O., Sortland, O.: Myelography. Textbook and atlas. Oslo: Tanum-Norli 1978 4. Vogelsang, H., Schmidt, R.: Cervical myelography (lateral approach) with inetrizamide. Acta Radiol. [Suppl.] (Stockh.) 355, 164-167 (1977) Received: 31 October 1978 Dr. med. R. C. Schmidt Abteilung fiir Neuroradiologie Medizinische Hochschule Karl-Wiechert-Allee 9 D-3000 Hannover 61, FRG
Neuroradiology 17, 183-184 (1979)
© by Springer-Verlag 1979
Cervical Double Contrast Myelocisternography by the Lateral Approach (Technical Note) R. C. Schmidt Department of Neuroradiology, Medical School, Hannover, Germany
Summary. A simple method for the combined examination of the cervical spinal canal with Amipaque, and of the craniocervical junction with air, by one and the same puncture without changing the patient's position during the examination, is described. Key words: Contrast media - Cervical myelography - Craniocervical junction
raparesis with or without sensory disturbances or a circumscribed neurological level, if no reason is found for the symptomatology in the cervical spinal canal. This was well done by gas myelography, although a filling of the fourth ventricle is not always attained. This method Seems to be obsolete because of the much better visibility of the intrathecal structures obtained with the water-soluble contrast medium Amipaque [3, 4]. Double contrast myelocisternography by the lateral approach fills this need.
Introduction Method
There is a diagnostic gap in ~Jl positive contrast myelographies concerning the dorsal parts of the craniocervical junction. An examination of this region is especially wanted for cases of spastic tet-
Cervical myelography is performed by the lateral approach C1-2 on the Mimer III and rotating chair RTC-3 (Siemens-Elema) in the prone position
Fig. 1. Positioningof patient for cervical double contrastmyelocisternography, lateral tomography 0028-3940/79/0017/0183/$01.00
184
R.C. Schmidt: Cervical Double Contrast Myelocisternography
Fig. 2. Lateral xerotomogram with good visualization of spinal subarachnoid space, prepontine and cerebellomedullary cisterns, fourth ventricle, aqueduct and posterior third ventricle
(Fig. 1) as previously described [1]. We prefer to introduce the needle in the dorsal subarachnoid space. The outline of the spinal cord is thereby more homogeneous than with ventral puncture. The procedure is easier because the space dorsal to the spinal cord is wider, and the vertebral ax~tery cannot be damaged. We use 6-10 ml Amipaque with a concentration of 170 mg I/ml. If there is no pathological finding on myelography, we inject about 10 ml of air by the same route, without changing the position of the patient. The air fills the cerebellomedullary cistern, fourth ventricle, aqueduct, and posterior parts of the third ventricle. A small amount of Amipaque usually goes up or can easily be moved to the preponfine cistern. Lateral tomography is performed. The structures of the posterior fossa and the craniocervical junction are thus well outlined by positive and/or negative contrast (Fig. 2).
Discussion
We have prefered the lateral cervical approach since we started to use Amipaque for myelography in August 1975. Smaller amounts of the contrast medium are required, so there are fewer sequelae than after thoracic and cervical myelography by the lumbar route [4]. Visualization of the intraspinal structures is invariably excellent, but the diagnostic value of gas myelography is greater at the craniocervical junction. Skalpe [2] visualizes this region by
turning the patient form the prone to the supine position at the end of the examination. The amount of contrast medium that passes into the intracranial spaces is thus not to be estimated. We have tried to combine the advantages of both positive and negative contrast media without the disadvantages of greater discomfort and the frequency of side effects with higher doses of both media, and have eliminated turning the patient. This method is easy to perform, gives good visualization of the structures to be seen, and lowers the risk and discomfort of the examination.
References 1. Schmidt, R. C.: Die zervikale und thorakale Myelographie mit dern neuen wasserl6slichen Kontrastmittel Metrizamide (Amipaque). Akt. Neurol. 5, 97-104 (1978) 2. Skalpe, I. O.: Zervikale Myelographie rnit Metrizamid (Amipaque). Akt. Neurol. 4, 189-193 (1977) 3. Skalpe, I, O., Sortland, O.: Myelography. Textbook and atlas. Oslo: Tanum-Norli 1978 4. Vogelsang, H., Schmidt, R.: Cervical myelography (lateral approach) with inetrizamide. Acta Radiol. [Suppl.] (Stockh.) 355, 164-167 (1977) Received: 31 October 1978 Dr. med. R. C. Schmidt Abteilung fiir Neuroradiologie Medizinische Hochschule Karl-Wiechert-Allee 9 D-3000 Hannover 61, FRG
