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World Neurosurg. 2017 May;101:816.e1-816.e3. doi: 10.1016/j.wneu.2017.02.086. Epub 2017 Feb 27.

A Small Leak Will Sink the Brain: Targeted C1-C2 Patching.

Author information

1
Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium. Electronic address: thomas.decramer@uzleuven.be.
2
Department of Neurosurgery, University Hospitals Leuven, Belgium.
3
Department of Neurology, University Hospitals Leuven, Belgium.
4
Department of Radiology, University Hospitals Leuven, Belgium.
5
Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium.

Abstract

BACKGROUND:

Spontaneous intracranial hypotension syndrome results from spontaneous spinal cerebrospinal fluid (CSF) leaks. The first treatment of choice consists of lumbar epidural blood patching. If this fails, further imaging is mandatory to explore the possibility of targeted therapy.

CASE DESCRIPTION:

We describe a case of a 50-year-old woman who developed spontaneous intracranial hypotension after minor blunt cervical trauma, complicated with bilateral subdural hematomas. Two lumbar epidural blood patches were unsuccessful. Magnetic resonance imaging with intrathecal gadolinium revealed a CSF leak at the C1-C2 level. A targeted blood patch via a percutaneous high thoracic epidural approach was performed, and symptoms disappeared in the immediate postoperative period with a regression of the subdural hematomas on subsequent imaging.

CONCLUSIONS:

A targeted epidural blood patch using an epidural catheter represents an elegant approach to a CSF leak at the C1-C2 region and can be successful in treating patients with severe intracranial hypotension syndrome.

KEYWORDS:

CSF leak; Epidural blood patch; Spinal catheter; Spontaneous intracranial hypotension

PMID:
28254591
DOI:
10.1016/j.wneu.2017.02.086
[Indexed for MEDLINE]

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