CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension

Kranz, Peter G.; Gray, Linda; Taylor, Jeffrey

doi:10.3174/ajnr.a2384

Cited by 56 publications

(33 citation statements)

References 27 publications

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“…To the best of our knowledge, the detailed analysis of CT myelography, which is less invasive and can be performed easily on a routine basis, has yet to be described in the literature. 2,8,[16][17][18] The study reported here raises the following 4 points with regard to the diagnosis and treatment of spontaneous CSF leaks. First, EBP at the level near the spinal lesions resulted in good outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, the number of levels of intraforaminal extravasation of contrast medium results in lower specificity for the detection of leaks. 8 For patients without definite spinal lesions, the potential leak site was determined on the basis of the contrast gradient hypothesis: the comparison of concentrations of contrast medium between the intradural and extradural spaces on CT myelography (Fig. 2); the extradural spaces were also targeted for EBP and resulted in good outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Although the use of targeted EBP is increasingly being reported, previous studies have not described in detail how to determine the leak site and target the spinal level for EBP. 8,[16][17][18] A common cause of CSF leaks is considered to be a ventral dural defect or meningeal diverticulum at the dural root sleeves. 3 In terms of leakage detection, the diagnostic method with the highest sensitivity is CT myelography.…”

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confidence: 99%

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Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac

Yoshida¹,

Takai²,

Taniguchi³

2014

SPI

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Object The purpose of this study was to describe significant CT myelography findings for determination of the leak site and outcome of targeted epidural blood patch (EBP) in patients with spontaneous CSF leaks. Methods During 2005–2013, spontaneous CSF leaks were diagnosed for 12 patients with orthostatic headaches. The patients received targeted EBP on the basis of CT myelography assessments. Results Computed tomography myelograms revealed ventral extradural collection of contrast medium distributed over multiple spinal levels (average 16 levels). Intraforaminal contrast medium extravasations were observed at multiple spinal levels (average 8.2 levels). For 8 (67%) of 12 patients, spinal lesions were noted around the thecal sac and included calcified discs with osteophytes, an ossified posterior longitudinal ligament, and an ossified yellow ligament; lesions were mostly located ventral to the thecal sac and were in close contact with the dura mater. The levels of these spinal lesions were considered potential leak sites and were targeted for EBP. For the remaining 4 patients who did not have definite spinal lesions around the thecal sac, leak site determination was based primarily on the contrast gradient hypothesis. The authors hypothesized that the concentration of extradural contrast medium would be the greatest and the same as that of intradural contrast medium at the leak site but that it would decrease with increased distance from the leak site according to the contrast gradient. Epidural blood patch was placed at the level of spinal lesions and/or of the greatest and same concentration of contrast medium between the intradural and extradural spaces. For 10 of the 12 patients, the orthostatic headaches decreased significantly within a week of EBP and disappeared within a month. For the remaining 2 patients, headaches persisted and medical treatment was required for several months. For 3 patients, thick chronic subdural hematomas caused severe headaches and/or disturbed consciousness because of the mass effect of the hematomas, which were removed by bur hole drainage surgery. For 1 patient, bur hole drainage before EBP on the day of admission to hospital resulted in subdural tension pneumocephalus. The patient's headache immediately disappeared after EBP, and the hematoma did not recur. The other 2 patients underwent EBP followed by bur hole drainage, which resulted in improvements and disappearance of the hematomas. Over the follow-up period (mean 39 months), no CSF leaks or chronic subdural hematomas had recurred in any patient after EBP; by the final follow-up visit, all patients had returned to their jobs. Conclusions The most significant finding of this study was that spinal ventral calcified or ossified lesions, which may be associated with a dural tear, were present in approximately 70% of patients. Targeted EBP to these lesions resulted in good outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac

Yoshida¹,

Takai²,

Taniguchi³

2014

SPI

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“…9 Prior authors have reported symptomatic improvement rates ranging from 50% to 100% with site-directed epidural blood/fibrin patch procedures by using CT or fluoroscopic guidance. [10][11][12][13][14][15] These treatment options, however, often require epidural punctures in the upper thoracic and cervical spine. Epidural puncture in these regions is technically more challenging due the anatomy and the epidural space becoming smaller as you ascend from the lumbar to the cervical region.…”

Section: Discussionmentioning

confidence: 99%

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Griauzde¹,

Gemmete

Chaudhary³

et al. 2014

American Journal of Neuroradiology

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“…8) In up to 20 % of cases, the MRI is unremarkable, however. In addition to diagnosis, radiology also offers the possibility of interventional radiological therapy using an epidural blood patch [44].…”

Section: Symptomologymentioning

confidence: 99%

Radiological Diagnosis and Differential Diagnosis of Headache

Langner¹,

Kirsch

2015

Fortschr Röntgenstr

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Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common. Beside the clinical course headaches are classified as either primary or secondary, with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome. Key points: ??Headache can be differentiated in primary and secondary forms. ??Imaging plays an important role in differential diagnosis of secondary forms. ??Imaging should be performed in patients with concomitant systemic or neurologic symptoms. Citation Format: ??Langner S, Kirsch M, Hosten N Radiological Diagnosis and Differentialdiagnosis of Headache. Fortschr R?ntgenstr 2015; 187: 879???891

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CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension

Cited by 56 publications

References 27 publications

Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac

Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Radiological Diagnosis and Differential Diagnosis of Headache

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