0:00

So let's start with the ultra fast, uh, pressure neutral CT myography. Um,

0:04

it does have a significant advantage and again,

0:06

those high flow leaks over conventional delayed myelogram 'cause you can get

0:09

that pinpoint accuracy of the,

0:11

of the exact locational leak when you have a large complex pseudo and inusal

0:14

that otherwise might be obs might obscure the actual location of the leak. Um,

0:19

we perform at start to finish at U C SS D and CT with both the LP and the

0:23

myelogram on the, in, on the same table.

0:25

The head is lowered right after the contrast I inject is injected. Normally,

0:29

I I perform the CT fairly quickly after. Um, I do use, uh,

0:33

a smart prep to actually,

0:34

to detect when it's getting into the region and then it,

0:37

it triggers and it'll scan the entire region of interest basically. Um, uh,

0:42

and this is just sort of the, the, uh, extensive details.

0:45

I'm not gonna read all of this to you,

0:46

but I tend to use a coaxial system to do the puncture so that I make a smaller

0:50

puncture. I use a 25 gauge for the dural puncture.

0:53

The reason you can get away for get away with this is because you're infusing

0:57

the entire contrast bolus in the, in the lumbosacral spine with the patient's,

1:00

um, uh, head elevated.

1:02

So you can infuse the entire thing at whatever rate you want.

1:05

You don't have to infuse it as quickly as you would for a D Ss M. Um,

1:08

and normally I use omnipaque two 40 for these higher flow leaks. You'll see I,

1:12

I I talk about using, uh, denser contrast, Omnipaque 300. For those, uh,

1:16

for those slower leaks, it is a little bit more helpful.

1:19

But normally I use two 40 for these, um,

1:21

higher flow leaks and normally I remove the needle before I even get ready to

1:25

scan. I usually remove the bolster and then again do a single slice, um,

1:28

and trigger a smart prep to, to actually, um, do the scan.

1:31

It typically takes about 15 seconds for the contrast to reach the csun.

1:36

So if you just wanna trigger it based on time,

1:38

you could do it after about 15 seconds and you'll probably catch most of them.

1:41

Uh, and generally I only perform a, a, a region where I'm,

1:45

I have concern based on the m r I like just the region of the,

1:48

the pseudo meninga seal that I'm concerned about. Um,

1:51

and if no leak is detected,

1:53

I will often roll them into the prone position and immediately repeat the scan

1:56

and just take a look and see if there's anything else that I'm missing.