Post-Laminectomy Cerebrospinal Fluid Fistula Treated With Epidural Blood Patch

Maycock, Neil F.; Essen, J. van; Pfitzner, J.

doi:10.1097/00007632-199410000-00018

Cited by 55 publications

(35 citation statements)

References 5 publications

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“…This headache is thought to be caused by a leakage of cerebrospinal¯uid after puncture of the dura eg for spinal anesthesia. However, some authors used this technique to seal cerebrospinal¯uid ®stulae following laminectomy 20 or other surgical procedures, 14,15,21 avoiding surgical revision which has been the traditional way of treatment. 12 Only one report described the successful treatment of an open (cutaneous) cerebrospinal¯uid ®stula by an epidural blood patch in the presence of an intrathecal catheter.…”

Section: Resultsmentioning

confidence: 99%

Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system

et al. 1999

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The treatment of lumbar cerebrospinal¯uid ®stula in the presence of an intrathecal catheter is known to be dicult. Open revision surgery is recommended in the literature, although the rate of recurrence is high. The epidural blood patch technique is well established as a successful treatment for post-dural-puncture headaches. Recent work about the distribution of the injected blood and theoretical considerations about the mechanism of action make this method suitable for the occlusion of spinal leakage even in the presence of an intrathecal catheter. In this note technical details are given for a successful therapy of lumbar cerebrospinal¯uid ®stula including the right positioning of the opening of the needle (cerebrospinal¯uid can be expected intrathecally and epidurally) by injection of contrast medium ®rst for myelography then for epidurography. In this procedure the (epidural) distribution of autologous blood can be indirectly controlled by compression of the dural sac. The method is easy to perform, and the possible risks are small.

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Section: Resultsmentioning

confidence: 99%

Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system

et al. 1999

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“…They have occurred following spinal surgery [1][2], long-and short-term intrathecal catheters [3][4][5][6][7][8][9][10][11], diagnostic and therapeutic lumbar punctures [12], combined spinal and epidurals (CSE) [13], epidural catheters [14][15][16][17][18][19][20], and one-shot epidural anesthetics and steroid injections [21][22][23]]. An overview of CSF-cutaneous fistula reports is presented in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options have included more conservative measures such as sterile dressings [6,11,19,20,23], fluids, and bed rest in positions to minimize CSF pressure on the presumed dural defect as well as minimize dural traction: lateral decubitus +/-hip flexion, prone +/-a pillow under the abdomen, slight trendelenberg [2,[4][5][6]18,21,23]. Dehydration and glycerol have been trialed [21], presumably to decrease CSF pressure and therefore promote fistulous tract healing.…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous stitching of the outflow defect has been used [4,5,13,21]. Epidural blood patches have been reported to be successful [3,4,[6][7][8][9]11,12,14,16,20,21] even in cases of fistulas due to surgical defects [1,2]. Subcutaneous infiltration around the fistula with saline has been suggested [4].…”

Section: Discussionmentioning

confidence: 99%

“…Subcutaneous infiltration around the fistula with saline has been suggested [4]. And finally, more invasive solutions such as use of fibrin glue, tract scarification and surgical correction have also been reported [2,9,22]. These treatments have been used alone and also in combination.…”

Section: Discussionmentioning

confidence: 99%

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Persistent cerebrospinal fluid-cutaneous fistula after epidural analgesia: a case report and review of literature

Tsai¹,

Ahmed²,

Wang³

2014

J Anesthesiol Clin Sci

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Presented is a case of persistent high-output cerebrospinal fluid (CSF) leak following epidural catheter removal on postoperative day 5 for a 64-year-old patient after exploratory laparotomy. Epidural catheter placement required multiple attempts preoperatively and was complicated by a "wet tap". Diagnosis of CSF leak was made with glucose, protein and beta-2 transferrin testing. In our review of 30 cases with reported CSF-cutaneous fistula, a trend towards requiring epidural blood patch for symptom relief exists when larger bore needles are used (all 9 reports involving 14 gauge or larger needles and 2 reports of fistulas resulting from a surgical defect) and duration of catheter stay is long. Notably, there were 3 case reports of CSF-cutaneous fistulas occurring without the placement of a catheter. Among 9 cases of fistula reported in the obstetric population, only one patient needed EBP for symptom control. Location of the needle/catheter insertion site at different levels of the neuraxium does not appear to affect the risk of developing a CSF-cutaneous fistula. CSF-cutaneous fistulas are a rare event that should be recognized early due to the potential for infections and neurologic complications. Glucose and protein testing offer a rapid but less specific means of diagnosing a possible CSF leak and can be used as guidance while awaiting results from beta-2 transferrin or beta-trace protein testing for definitive identification of CSF. With literature review, we propose an algorithm to help early detection and management of CSF-cutaneous fistula.

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