Cervical Foraminal Epidural Blood Patch for the Targeted Treatment of Refractory Cerebrospinal Fluid Leakage From a Dural Sleeve

Tontisirin, Nuj; Benjhawaleemas, Pannawit; Nimmaanrat, Sasikaan; Sathirapanya, Pornchai; Laohawiriyakamol, Teeranan; Tran, De Q.H.; Finlayson, Roderick J.

doi:10.1097/aap.0000000000000696

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…It is therefore important to apply EBP at the site of CSF leak even if the site of CSF leak is at a higher spinal level. Although a patient with SIH due to CSF leakage at the C7–T1 level failed to respond to EBP treatment at the T9–T10 level, a repeat EBP performed by targeting the site of leakage at the C7–T1 level resolved this patient’s symptoms [ 17 ]. Cervical EBP at the C6–7 level successfully resolved symptoms in a patient with SIH [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report

et al. 2020

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“…While dural tear may occur anywhere along the spinal axis, laceration, and subsequent CSF leakage at the nerve root sleeve may be relatively rare: PubMed search using the keywords IC and root sleeve yielded only seven previous cases [Table 1]. [15][16][17][18][19][20][21] As shown in Figure 2b, reconstructed coronal view of the CT myelogram may particularly be useful to identify CSF leakage occurring at the root sleeve.…”

Section: Discussionmentioning

confidence: 99%

“…Year of publication Spinal level Pleasure et al [15] 1998 Lumbar Schievink and Jacques [16] 2003 Cervical Watanabe et al [17] 2009 Thoracic Ohtonari et al [18] 2009 Lumbar Cheshire and Wharen [19] 2009 Cervical Hasiloglu et al [20] 2012 Thoracic/thoracic Tontisirin et al [21] 2018 Thoracic Present case 2018 Thoracic…”

Section: Authormentioning

confidence: 99%

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient

2019

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We present a rare case of traumatic acute subdural hematoma (SDH) in which intracranial hypotension (IC) secondary to cerebrospinal fluid (CSF) leakage at the lumbar spine caused delayed neurological deterioration. A 70-year-old male sustained a head injury after ground-level fall and was brought to our institution. A brain computed tomography (CT) showed a thin acute SDH with mild brain shift, and conservative management was initiated. He exhibited neurological deterioration on the 9th hospital day, however, and a brain CT showed a change in CT density and marked an increase in hematoma volume and brain shift. It was thought that conversion from acute to subacute SDH was associated with the deterioration, and emergency hematoma evacuation was performed. Despite the surgery, neither clinical nor radiographical improvement occurred. The lack of improvement pointed to the presence of underlying IC, and a CT myelography revealed the dural sleeve of the right L2 nerve root as the source of the CSF leakage. An epidural blood patch therapy was performed on the 12th hospital day to seal the CSF leakage. The postprocedural course was uneventful, and the patient was discharged free of symptoms on the 20th hospital day. Spinal CSF leakage should be considered as a cause of delayed neurological deterioration in patients with traumatic acute SDH which exhibits conversion to subacute SDH.

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<p>Targeted Epidural Blood Patches Under Fluoroscopic Guidance For Incidental Durotomies Related To Spine Surgeries: A Case Series</p>

Wong

Rasouli

et al. 2019

JPR

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IntroductionIncidental durotomies are usually managed conservatively. However, 1.8% of patients require surgical dural repair for CSF leak. There are limited data available regarding the use of epidural blood patches (EBP) for persistent CSF leaks secondary to incidental durotomies. This case series aims to evaluate the efficacy of targeted EBPs under fluoroscopic guidance in the treatment of incidental durotomies.MethodsFour patients with incidental durotomies after spine surgeries (one cervical decompression, one revision of L5-S1 decompression and fusion, and two lumbar decompressions) were included in this series. These patients did not respond to conservative management and subsequently underwent EBPs. Magnetic resonance imaging (MRI) images were reviewed to confirm and identify the sites of CSF leak prior to the EBPs. We targeted the sites of CSF leak with fluoroscopic guidance. All four patients received an EBP with an 18-gauge epidural needle placed under fluoroscopic guidance. In some cases, epidural catheters were used to further target the sites of CSF leak. Contrast was used to confirm the appropriate placements of the needles and catheters. Approximately 5–14 mL of autologous blood was injected through the needles or catheters to the sites of dural leak.ResultsThree lumbar and two cervical EBPs were performed in four patients (two females and two males). Their age ranged from 44 to 73 years old. Two out of three patients who had lumbar EBP reported complete resolution of symptoms following EBP. The patient who had cervical epidural patches did not have improvement in her symptoms.ConclusionThis case series demonstrated that targeted EBP can be an effective treatment for CSF leak from incidental durotomies. However, dural tears in the cervical region may be more difficult to treat. Larger scale studies are required to evaluate efficacy of EBP in the treatment of symptomatic incidental durotomies.

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Cervical Foraminal Epidural Blood Patch for the Targeted Treatment of Refractory Cerebrospinal Fluid Leakage From a Dural Sleeve

Cited by 4 publications

References 14 publications

Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report

Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient

<p>Targeted Epidural Blood Patches Under Fluoroscopic Guidance For Incidental Durotomies Related To Spine Surgeries: A Case Series</p>

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