[legalnomads]

For clarity, I had 4 rounds of targeted patching done, but I wanted to be clear that there were a total of 22 needles — it wasn't a high volume EBP, but smaller, directed patches with blood+fibrin.

Puncture leak sites rarely show on imaging, it's true. At Duke, Cedars, or other leak centers they have techniques for CTMs or DSMs that yield leak sites but that's usually for spontaneous CSF leak patients or post-surgical, not us puncture people. They're using a PCCT machine to find CSF venous fistulas at Mayo and at Duke, but again to my knowledge puncture leaks remain a needle in a haystack even on that quality of imaging.