0:01

But that I'll, I'll move, move on to digital subtraction. Myography, uh, again,

0:04

digital subtraction myography is really heavily reliant upon m r i ahead of time

0:09

to kind of know whether we're dealing with a high flow or, or a low flow leak.

0:12

And as we'll put them either in the prone position if it's a high flow leak or a

0:16

lateral decubitus position. If it's a, uh, a slower leak,

0:21

I usually use as you need to inject very quickly, uh,

0:23

because the patient's either gonna be under general anesthesia with a breath

0:26

hold, or you're gonna be having them hold their breath and injecting quickly and

0:29

watching the contrast flow up with a mask, uh, or with, uh, a negative roadmap,

0:33

either one. Um, I normally use omni two 40 again for those high flow leaks,

0:37

but I use 300 for the slow flow leaks just to get a little bit better

0:40

visualization. Um,

0:42

and then you can raise their pressure with Elliot BSS if it's one of those

0:45

slower flow leaks. Um, but again, the position is critical.

0:48

So if they have perineural cysts on the M R I, I put 'em,

0:51

the lateral to CBI position in the most sus the sort of focus on the most

0:54

suspicious regions on the M R I. And then if they have a high flow leak or a,

0:58

um, a pseudomeningocele detected on M R I,

1:00

then I focus on that area and I put them in the prone position. Um,

1:03

usually 'cause the, the, the pseudo and inae is, uh, in the, um,

1:07

in the ventral epidural space. That being said,

1:09

sometimes pseudo meninga seals are lateral with type two leak,

1:11

so sometimes we'll put 'em in the, uh, lateral decubitus position, uh,

1:15

if even if it is a high flow leak,

1:16

if we believe it's one of those lateral type two leaks.