Epidural blood patch for the treatment of liquor hypotension after intrathecal chemotherapy in a 10-year-old: case report

Management of Post-Dural Puncture Headaches in Pediatric Patients with Epidural Blood or Saline Patch: An Educational Focused Review

“…In addition to the reports in the adult population, both EBP and ESP have been used to control pediatric PDPH resistant to conservative measures (Tables 1-2). [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The first of these reports was published in 1984. Purtock RV et al reported a 9-year-old, 39 kg boy who developed severe bifrontal postural headache with nausea and vomiting after diagnostic lumbar puncture.…”

“…2,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] All of these reports are relatively anecdotal with 15 being single patient case reports and two being retrospective case series including 41 and 7 patients. The first and largest series to date was reported by Kokki et al, who evaluated the effectiveness of EPB in 41 pediatricaged patients over a 10-year period at two different hospitals.…”

Epidural cerebrospinal fluid leak with neurologic abnormalities after intrathecal therapy in a female with acute lymphoblastic leukemia

“…Although epidural CSF leak caused by lumbar puncture (LP) without IT has been reported to improve conservatively, [2][3][4] there were only two reports of patients with epidural CSF leak or subarachnoid cutaneous fistula after IT for the prevention of central nervous system (CNS) leukemia. Both patients were treated with epidural blood patch (EBP) because their symptoms such as increasing edema over the lower back or orthostatic headaches did not improve by 72 h. 5,6 An EBP is a procedure in which autologous blood is injected into the epidural space at the site of CSF leak. In leukemia, the indication for EBP should be determined by the minimal residual disease status of the peripheral blood and the CNS disease.…”

“…In previous reports of epidural CSF leak due to LP without IT, neurological abnormalities, such as lower-extremity weakness, healed conservatively, without sequelae. [2][3][4] On the other hand, only two patients with epidural CSF leak or subarachnoid cutaneous fistula after IT underwent EBP because their symptoms did not improve within 72 h. 5,6 Although EBP is considered safe and effective in adult patients, 7 Strand et al 9 reported that one out of 19 patients with leukemia or lymphoma who received EBP, developed new CNS involvement. Additionally, LPs for EBP have potential risks with subdural abscesses and septicemia.…”