* CISTERNOGRAGHY-USEFUL TIPS *

1*ANY TRACER OUTSIDE THE CSF SPICE IS ABNORMAL*
*PLEDGETS INSERTED INTO THE NASOPHARYNX WHICH ARE REMOVED AT 6 HOURS AND COUNTED ALONG WITH A SAMPLE OF BLOOD INCREASE THE SENSITIVITY FOR SMALL LEAKS. PLEDGET/SERUM RATIO SHOULD BE LESS THAN 1.3:1*
*TILTING THE HEAD FORWARD OR PERFORMING A VALSALVA MANOEUVRE MAY INCREASE SENSITIVITY*
*SPINAL DURAL LEAKS CAN ALSO BE LOCALIZED*
*AN IMAGE SHOULD BE OBTAINED OF THE SPINAL INJECTION SITE, SINCE INFILTRATED TRACER WILL AFFECT RESULTS*

2*THERE SHOULD BE RAPID PASSAGE OF THE TRACER DISTALLY WITH APPEARANCE IN THE PERITONEUM OR CIRCULATION (eg KIDNEYS). THE SPEED WILL DEPEND ON THE CSF PRESSURE AND FLOW RATE, BUT SHOULD BE SEEN WITHIN 1-2 HOURS*
*PROXIMAL FLOW OF TRACER MAY OR MAY NOT BE SEEN, DEPENDING ON THE RESERVOIR VALVE TYPE*
*IT IS IMPORTANT TO CHECK FOR MISINJECTION IN THE SCALP, SINCE THIS CAN PRODUCE SYSTEMIC UPTAKE*
*LUMBAR-PERITONEAL SHUNT CAN BE CHECKED BY LUMBAR SUBARACHNOID INJECTION AND FOLLOWING TRACER PASSAGE INTO PERITONEUM*

*CISTERNOGRAGHY IMAGING INTERPRETATION*
*BRAIN CLINICAL APPLICATIONS*
* CENTRAL NERVOUS SYSTEM *