Ultrasound-guided epidural blood patch

Gnaho, Alexandre; Nguyen, Vina P.; Déserts, Marc Danguy des; Bonnet, Francis

doi:10.1097/eja.0b013e3283350c7c

Cited by 10 publications

(4 citation statements)

References 4 publications

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“…Ultrasound-guided access has been previously described as an efficacious and safe technique for lumbar puncture, epidural blood patches, and steroid injections. [8][9][10][11] A large retrospective study of ultrasoundguided lumbar puncture in pediatric patients showed a technical success rate of 95.4% with no adverse events. 8 A follow-up study incorporated planning US to confirm CSF adequacy prior to LP and resulted in a 100% technical success rate.…”

Section: Discussionmentioning

confidence: 99%

Combined ultrasound and fluoroscopy guided tunneled external lumbar drain placement in children

Bertino

Shin

Weaver

et al. 2021

J of Clinical Ultrasound

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External lumbar drain placement has been shown to be an efficacious and safe approach to managing various forms of intracranial hypertension in adult patients and children. The use of ultrasound guidance for lumbar punctures in young patients has been described however, but the modality is not routinely used for the placement of tunneled lumbar drains. In this report, two cases are presented that detail experience using ultrasound guidance for tunneled lumbar drains in children.

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Section: Discussionmentioning

confidence: 99%

Combined ultrasound and fluoroscopy guided tunneled external lumbar drain placement in children

Bertino

Shin

Weaver

et al. 2021

J of Clinical Ultrasound

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“…Although previous reports have described the use of US assistance to place EBPs in postoperative patients, none have described the use of CFD to precisely localize the point of CSF egress. [9][10][11][12] Identifying this point is of central importance to ensuring the effectiveness of the EBP. Consider the analogy of applying pressure to tamponade venous bleeding-the same amount of pressure applied to 2 sites a few centimeters apart can represent the difference between success and failure.…”

Section: Discussionmentioning

confidence: 99%

“…US-assisted EBP placement has been previously described to treat CSF leaks associated with lumbar punctures and postsurgical pseudomeningocele in pediatric patients. [9][10][11] An additional case series described the utilization of "fourdimensional" US to monitor the deposition of the EBP in postoperative patients in real time. 12 No previous studies in the literature have described the use of doppler US in the diagnosis or treatment of CSF leaks.…”

mentioning

confidence: 99%

Application of Color Doppler Ultrasound to Identify and Repair Postoperative Cerebrospinal Fluid Leak: A Technical Note

West

Abode-Iyamah

Chen

et al. 2021

Operative Neurosurgery

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BACKGROUND:Incidental durotomy is a known complication of spinal surgery. Persistent cerebrospinal fluid (CSF) leak after unrecognized durotomy may lead to prolonged hospitalization and significant morbidity. If initial bed rest fails, the surgeon must choose between nontargeted methods such as oversewing the wound and lumbar drain placement or return to the operating room.OBJECTIVE:To report the novel use of color flow doppler (CFD) in conjunction with ultrasound (US) to localize the point of CSF leak, assist with aspiration of the pseudomeningocele, and direct the application of fibrin sealant or epidural blood patch.METHODS:This article includes a description of the technique as a technical note.RESULTS:A 72-year-old man underwent L2-5 laminectomies for spinal stenosis. During the index operation, a durotomy occurred and was repaired primarily. The patient subsequently developed leg weakness, back pain, and bulging of the incision. Using CFD, the site of durotomy was determined. Under direct visualization, 34 mL of CSF was aspirated from the pseudomeningocele and 20 mL of fibrin sealant was placed opposing the durotomy. At 2-month follow-up, CFD confirmed absent flow and MRI demonstrated pseudomeningocele resolution.CONCLUSION:This article represents the first report highlighting the utility of CFD US to guide epidural patch placement for postsurgical CSF leaks. CFD allows localization of the durotomy and direct application of blood or fibrin sealant, potentially increasing the success rate of epidural blood patch in postoperative patients. This approach is less invasive than revision surgery and does not require the prolonged hospitalization of lumbar drainage or other nontargeted interventions.

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“…380 417 421 Three case reports described ultrasound-guided EBP for PDPH. [422][423][424] In these cases, ultrasound was used for landmark clarification and depth of the epidural space prior to the EBP procedure.…”

Section: Radiological Guidancementioning

confidence: 99%

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Uppal,

Russell,

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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IntroductionPostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.MethodsBased on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.ResultsBased on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.ConclusionsThese clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients’ interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.

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Ultrasound-guided epidural blood patch

Cited by 10 publications

References 4 publications

Combined ultrasound and fluoroscopy guided tunneled external lumbar drain placement in children

Combined ultrasound and fluoroscopy guided tunneled external lumbar drain placement in children

Application of Color Doppler Ultrasound to Identify and Repair Postoperative Cerebrospinal Fluid Leak: A Technical Note

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

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