Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak: a case report

Fujiwara, Aki; Watanabe, Keisuke; Hashizume, Kazuyoshi; Shinohara, Kozue; Fukumoto, Michiko; Kimoto, Katsuhiro; Kawaguchi, Masahiko

doi:10.1186/s40981-016-0073-2

Cited by 4 publications

(3 citation statements)

References 22 publications

(13 reference statements)

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“…It requires that the operator have combined skills in fluoroscopy (historically more common among chronic pain physicians) and in ultrasound (historically more common among regional anesthesiologists/acute pain physicians). If prolonged postdural puncture headache were to occur, epidural blood patch could be approached using a transforaminal approach 9 10. The requirement for fluoroscopy may preclude consideration of spinal anesthesia via this approach for cesarian delivery in patients with previous full-spine fusions.…”

Section: Discussionmentioning

confidence: 99%

“…If prolonged postdural puncture headache were to occur, epidural blood patch could be approached using a transforaminal approach. 9 10 The requirement for fluoroscopy may preclude consideration of spinal anesthesia via this approach for cesarian delivery in patients with previous full-spine fusions. Transient paresthesias occurred, though no patient in this series had a persistent nerve root injury.…”

Section: Discussionmentioning

confidence: 99%

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Transforaminal lumbar puncture for spinal anesthesia or novel drug administration: a technique combining C-arm fluoroscopy and ultrasound

Berde

Formanek

Khan

et al. 2022

Reg Anesth Pain Med

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BackgroundLumbar puncture (LP) may be challenging for patients with scoliosis and other conditions following previous posterior fusion and instrumentation from thoracic to sacral levels. Interventional radiologists have described CT approaches to transforaminal LP. We hypothesized that combined C-arm fluoroscopy and ultrasound could be a feasible approach to transforaminal LP for interventional pain physicians and regional anesthesiologists.MethodsWith institutional review board approval, we reviewed medical records and imaging of six patients with spinal muscular atrophy and prior spine fusion. Non-cutting needles of 24 or 25 gage were advanced through 20-gage introducers. Prior imaging guided selection of a preferred side and spinal level. Initial procedures were performed in the interventional radiology suite. Subsequent procedures were performed in an operating room (OR). We report on technical success and complications and describe a case using this approach for spinal anesthesia.ResultsSix patients underwent a total of 54 transforaminal LPs, including 51 for administration of the antisense oligonucleotide nusinersen, 2 for myelography, and 1 for spinal anesthesia; 45 of these procedures were performed using OR C-arm fluoroscopy and ultrasound. Transient paresthesias and short-term headaches occurred; none required intervention. No other complications were noted.ConclusionsTransforaminal LP appears technically feasible for patients with full-spine fusions using a straight-needle approach with combined fluoroscopy and ultrasound guidance. Larger case series and prospective studies may better define the success rates, risks, and benefits of this approach relative to alternative approaches to intrathecal access for patients with previous long-segment posterior spine fusions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transforaminal lumbar puncture for spinal anesthesia or novel drug administration: a technique combining C-arm fluoroscopy and ultrasound

Berde

Formanek

Khan

et al. 2022

Reg Anesth Pain Med

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“…Examples of circumstances in which interlaminar EBP may be impractical or inadvisable include infection at the injection site, the presence of surgical wounds or scarring, or the use of anticoagulation agents (10)(11)(12)(13)(14). We report a case of successful administration of EBP via a caudal approach for treatment of SIH-related chronic headache in a patient receiving dual antiplatelet therapy with aspirin and clopidogrel.…”

Section: Introductionmentioning

confidence: 99%

Caudal Epidural Blood Patch for Spontaneous Intracranial Hypotension in a Patient Receiving Dual Antiplatelet Therapy

Kaye¹

2020

PMCR

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Background: Epidural blood patch (EBP) is routinely used to treat spontaneous intracranial hypotension (SIH). In the case of a patient receiving dual antiplatelet therapy, a caudal EBP was utilized for treatment of his SIH-related chronic headache as the traditional lumbar interlaminar approach was not advisable due to bleeding risk. While there are case reports supporting the efficacy of caudal EPB for treating SIH, none of the cases were performed in patients receiving antiplatelet therapy. In this case, we were uncertain whether antiplatelet agents would interfere with clot formation in the epidural space and preclude successful blood patch formation. Case Report: Herein, we present a 50-year-old man diagnosed with SIH after presenting with a 2-month history of intractable, orthostatic, bifrontal headache. He had undergone coronary stenting 37 days prior and was receiving dual antiplatelet therapy with aspirin and clopidogrel. After the patient failed conservative measures, he elected to proceed with caudal EBP. This provided only 2 hours of symptom relief. One week later, another EBP was performed, this time with complete resolution of the patient’s headache. Conclusion: Our case demonstrates that the caudal approach to EBP may be a safe and effective alternative to interlaminar blood patch for treatment of spontaneous intracranial hypotension in patients at increased bleeding risk related to antiplatelet therapy. Key words: Epidural blood patch, caudal blood patch, CSF leak, postural headache, SIH, spontaneous intracranial hypotension, anticoagulation

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Spontaneous Intracranial Hypotension and Spinal Epidural CSF Leaks: Diagnosis and Management

Rajpal

Nambiar

Castanelli

et al. 2023

Journal of Clinical Neuroscience

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Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak: a case report

Cited by 4 publications

References 22 publications

Transforaminal lumbar puncture for spinal anesthesia or novel drug administration: a technique combining C-arm fluoroscopy and ultrasound

Transforaminal lumbar puncture for spinal anesthesia or novel drug administration: a technique combining C-arm fluoroscopy and ultrasound

Caudal Epidural Blood Patch for Spontaneous Intracranial Hypotension in a Patient Receiving Dual Antiplatelet Therapy

Spontaneous Intracranial Hypotension and Spinal Epidural CSF Leaks: Diagnosis and Management

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