Fluoroscopically guided epidural blood patch with subsequent spinal CT scans in the treatment of spontaneous cerebrospinal fluid hypovolemia.

Abstract:

OBJECT:Recent evidence has indicated that the efficacy of the epidural blood patch (EBP) in the treatment of spontaneous CSF hypovolemia (SCH) is still limited. Therefore, further improvement of the EBP technique is an important clinical challenge. The authors describe a series of cases of SCH treated with fluoroscopically guided placement of an EBP and followed up with subsequent spinal CT scans. METHODS:Thirteen patients with SCH that was proven on CT myelography studies underwent epidural puncture under fluoroscopic guidance and received an injection of a mixture of contrast medium and autologous blood. Contrast medium was injected to cover the area of CSF leakage during EBP guided by fluoroscopy, and the spread of the blood was subsequently evaluated using spinal CT scanning. If the amount of blood injected was insufficient to cover the leakage area, a second EBP was performed at a later date. RESULTS:At the first EBP procedure, a mixture with a mean volume of 9.4 ml (range 3-20 ml) was injected, and subsequent spinal CT scans revealed contrast enhancement in the desired epidural space in 12 of 13 patients. In 2 patients, a second EBP was required because of insufficient coverage of the leakage area or delayed recurrence of headache. In all patients, a complete recovery from orthostatic headache was obtained after the last EBP. CONCLUSIONS:The results indicated that fluoroscopically guided EBP and subsequent spinal CT scans may provide a highly effective therapy in patients with SCH proven on CT myelography studies.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Watanabe K,Hashizume K,Kawaguchi M,Fujiwara A,Sasaoka N,Furuya H

doi

10.3171/2011.1.JNS101326

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

1731-5

issue

6

eissn

0022-3085

issn

1933-0693

journal_volume

114

pub_type

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