Format

Send to

Choose Destination
World Neurosurg. 2018 Oct;118:e276-e282. doi: 10.1016/j.wneu.2018.06.171. Epub 2018 Jun 30.

Excellent Outcomes of Large-Volume Epidural Blood Patch Using an Intravenous Catheter in 15 Consecutive Cases with Cerebrospinal Fluid Leak.

Author information

1
Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan. Electronic address: ohtonari@shouwa.or.jp.
2
Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
3
Department of Neurology, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
4
Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
5
Department of Radiology, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.

Abstract

OBJECTIVE:

The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period.

METHODS:

Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively.

RESULTS:

Different types of headache were observed, including typical orthostatic headache alone (n = 10), orthostatic headache with chronic subdural hematoma (CSDH) (n = 3), and posture-unrelated headache accompanied with CSDH (n = 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases.

CONCLUSIONS:

We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.

KEYWORDS:

Cerebrospinal fluid hypovolemia; Cerebrospinal fluid leak; Chronic subdural hematoma; Epidural blood patch; Intracranial hypotension; Intravenous catheter

PMID:
29966793
DOI:
10.1016/j.wneu.2018.06.171
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center