Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch

Allmendinger, Andrew M.; Lee, Thomas C.

doi:10.1016/j.clinimag.2012.11.006

Cited by 15 publications

(9 citation statements)

References 14 publications

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“…B. Marfan-Syndrom) auch das weibliche Geschlecht zu sein [16,20,23]. Mögliche Ursachen sind häufig Bagatelltraumata und selten auch verkalkte Bandscheibenvorfälle oder Retrospondylophyten [2,29]. In vielen Fällen lässt sich jedoch keine eindeutige Ursache eruieren.…”

Section: äTiologie Des Liquorverlustsyndromsunclassified

“…Sollte der "blood patch" bei kleineren Leckagen auch nach der dritten Anwendung noch nicht suffizient sein, besteht als weitere Therapieoption die CTAbb. 2 gesteuerte Applikation eines Fibrinklebers an die Leckagestelle. Einzelne Autoren berichten auch über den zusätzlichen Einsatz epidural eingebrachter Katheter zur Applikation eines "blood patch" bei ventral gelegenen Liquorleckagen an der HWS oder BWS [13,17,26].…”

Section: "Blood Patch"unclassified

“…Der erste "blood patch" ist in bis zu 85% der Fälle wirksam, nach einmaliger Wiederholung wird bereits eine Wirksamkeitsrate von bis zu 98% erreicht [1,2,4,5,9,12,14,18,21,23,28]. Da manche Patienten mit spontanem Liquorverlustsyndrom auf mehreren Höhen Liquorlecks aufweisen, können mehrere "blood patches" auf verschiedenen Höhen erforderlich sein.…”

Section: Ergebnisseunclassified

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Liquorverlustsyndrom

Gottschalk

2015

Radiologe

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Section: äTiologie Des Liquorverlustsyndromsunclassified

Section: "Blood Patch"unclassified

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Liquorverlustsyndrom

Gottschalk

2015

Radiologe

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“…Five of the 7 reported cases of thoracic disc-associated SIH in the literature were treated with an EBP alone. Of the cases requiring EBP, 1 had complete relief after 1 EBP, 1 2 required multiple EBPs, 1,20 and 2 required both EBP and surgical evacuation of associated cranial subdural hematomas. 1,27 Prior to this case report, only 2 other cases of surgically treated thoracic disc-associated SIH had been documented in the literature with disparate methods of treatment.…”

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confidence: 99%

“…Of the cases requiring EBP, 1 had complete relief after 1 EBP, 1 2 required multiple EBPs, 1,20 and 2 required both EBP and surgical evacuation of associated cranial subdural hematomas. 1,27 Prior to this case report, only 2 other cases of surgically treated thoracic disc-associated SIH had been documented in the literature with disparate methods of treatment. 3,26 There is no standard or preferred approach for the surgical repair of spontaneous CSF leaks in the thoracic spine, and therefore we have drawn from the general literature with regard to the operative management of thoracic discs.…”

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confidence: 99%

Posterior thoracic laminoplasty with dorsal, intradural identification of ventral defect and transdural discectomy for a spontaneous cerebrospinal fluid leak: case report

Fehnel

Borges

2015

SPI

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Spontaneous intracranial hypotension (SIH) has been increasingly reported in the literature concomitant with the improved sensitivity of imaging modalities. Although typically associated with meningeal weakening, a handful of cases of SIH secondary to thoracic disc osteophytes have been reported. Five of 7 reported cases were treated with epidural blood patch (EBP) alone while 2 required surgical management. There is no standard operative approach; both anterior and posterolateral approaches can be cumbersome and associated with morbidity, particularly in young, healthy patients. The authors report a case of SIH in which a ventral dural tear secondary to a calcified thoracic disc was repaired via posterior thoracic laminoplasty with dorsal durotomy and intradural exposure of the ventral defect with transdural discectomy followed by primary closure. A 34-year-old man presented with low-pressure headaches following axial load injury from a ski accident 5 years earlier. The patient's symptoms were refractory to a trial of conservative treatment and EBP, and he developed bilateral upper-extremity paresthesias. MRI of the spine demonstrated an extrathecal collection spanning the thoracic spine, and dynamic CT myelography identified contrast extravasation adjacent to a calcified paramedian disc at T9–10. The patient underwent posterior laminoplasty with neuromonitoring. A ventral dural defect was visualized via a dorsal durotomy, the penetrating disc osteophyte was removed transdurally, and the ventral and dorsal dura maters were closed primarily. Both somatosensory and motor evoked potentials were unchanged during surgery. The patient has remained asymptomatic more than 10 months postoperatively and he has resumed work as a surgeon. Cases of SIH secondary to a calcified thoracic disc are rare with little precedent as to optimal surgical intervention. This case illustrates the potential usefulness of posterior laminectomy in nonmyelopathic patients in whom there is no evidence of canal compromise and for whom neuromonitoring is available. Additionally, surgeon experience and patient preference may guide surgical planning.

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