Devoted to diagnostic and interventional spine imaging and therapeutics


Image-Guided Interventional Procedures Of The Csf Space 2014

Category Interventional Hee Seok Jeong Joon Woo Lee Purpose In post-dural puncture headache patients and spontaneous intracranial hypotension patients, an epidural blood patch was performed with CT myeography and fluoroscopy and the therapeutic efficacy was compared. Materials & Methods There were a total of 16 subjects in this study diagnosed as post-dural puncture headache or spontaneous intracranial hypotension patients who were sent to the Department of Radiology for an epidural blood patch. In the epidural blood patch, after a patient was put into a prone position under an angiograph (Allura Xper FD 20; Philips Healthcare, Best, the Netherlands), the target epidural space was punctured with a 20G spinal needle and a contrast agent (Omnipaque 300 (iohexol, 300 mg of iodine per milliliter); Amersham Health, Princeton, NJ, USA) was injected to verify the epidural space. Then, 10-20 ml of the patient’s autologous blood that had been extracted in advance was injected. The puncture position in the epidural blood patch was the L3/L4 position for post-dural puncture headache patients. In the case of a spontaneous intracranial hypotension patient, CT myelography was firstly performed and then the position where epidural leakage of the contrast agent occurred greatly was determined as the puncture position. 10 ml of the autologous blood was injected Results six (37.5%) out of 16 patients showed complete alleviation and 10 patients (62.5%) showed incomplete alleviation. No treatment failure was found in any patients. Postural headache relapsed in 6 (60%) out of 10 patients who showed incomplete alleviation. In the post-dural puncture headache patient group, 5 (41.7%) out of 12 patients showed complete alleviation (41.7%) and 7 patients (58.3%) showed incomplete alleviation. On the contrary, in the spontaneous intracranial hypotension patient group, 1 (25%) out of 4 patients showed complete alleviation and 3 patients (75%) showed incomplete alleviation. Conclusion In both the post-dural puncture headache and spontaneous intracranial hypotension patients, an epidural blood patch with fluoroscopy showed excellent efficacy in improving the symptoms. References 1. Kokki M, Sjovall S, Kokki H. Epidural blood patches are effective for postdural puncture headache in pediatrics--a 10-year experience. Paediatr Anaesth 2012;22:1205-1210 2. van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry 2008;79:553-558 3. Kawaguchi M, Hashizume K, Watanabe K, Inoue S, Furuya H. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth 2011;25:450-453 4. Allmendinger AM, Lee TC. Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch. Clin Imaging 2013;37:756-761