Cerebrospinal fluid cutaneous fistula An unusual complication of epidural anaesthesia

Howes, J L; Lenz, Ryan

doi:10.1111/j.1365-2044.1994.tb03426.x

Cited by 19 publications

(7 citation statements)

References 8 publications

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“…This was a straightforward epidural insertion and the patient showed no signs of PDPH after. Possible factors that could contribute to delayed healing of the tract include immune compromise (including systemic steroid usage) [3,6,13], multiple attempts at the same vertebral level using the same needle, and the use of epidural steroids [14]. Again none of these apply to our patient.…”

Section: Casementioning

confidence: 85%

“…The main concern of an untreated CSF leak is meningitis. Epidural blood patch has been used effectively in several cases, both in adults [3,13] and children [2,7], and has been described to provide almost immediate relief to both CSF leakage and post dural puncture headache in a matter of hours. If the fluid leak fails to resolve after epidural blood patch and figure of eight stitches over the fistula site, Kumar et al have described successful treatment using subarachnoid catheter for CSF drainage [2].…”

Section: Managementmentioning

confidence: 99%

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Cerebrospinal Fluid Cutaneous Fistula after Uneventful Epidural Analgesia

Thong¹

2015

Glob J Anesth

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Cerebrospinous fluid (CSF)-cutaneous fistula is a rare complication of neuraxial blockade. We present a case of a healthy patient who developed cerebrospinal fluidcutaneous fistula after an uneventful epidural catheter insertion for perioperative analgesia. The patient was managed conservatively and the fistula resolved without further issues. The literature is reviewed for similar reports and diagnosis and management of this rare complication are discussed. an epidural infusion of ropivacaine 0.2% (with fentanyl 2mcg/ml) at 8ml/h. There was no motor block, respiratory compromise or hemodynamic instability. Discussion Cerebrospinal fluid fistula has been described as a consequence of neuraxial procedures such as spinal surgery [1] and intrathecal catheters and drains [2,4]. However, only a handful of case reports exist describing it in anesthetic practice, both in adults [3,5,6] and children [7].

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Section: Casementioning

confidence: 85%

Section: Managementmentioning

confidence: 99%

Cerebrospinal Fluid Cutaneous Fistula after Uneventful Epidural Analgesia

Thong¹

2015

Glob J Anesth

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“…Among 30,000 epidural catheters placed, there were no reports of persistent CSF leak or cutaneous fistula. Although the observation and diagnosis of a persistent CSF-cutaneous fistula is a rare event, anecdotal reports in both adult and children have demonstrated its occurrence following spinal surgery, placement of intrathecal catheters, combined spinalepidural anesthesia, diagnostic or therapeutic lumbar puncture, and epidural anesthesia [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. A summary of the reports from pediatric-aged patients is outlined in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Intermittent Cerebrospinal Leak After Inadvertent Dural Puncture During Epidural Catheter Placement for Postoperative Analgesia

et al. 2022

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Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be encountered during epidural needle placement, with catheter advancement, or subsequently during infusion of local anesthetic agents. We present the rare occurrence of a persistent cerebrospinal fluid (CSF) leak following inadvertent dural puncture (wet tap) during attempted placement of an epidural catheter in a 6-year-old child. Potential adverse effects of epidural anesthesia in children are discussed, and options for treatment of a persistent CSF leak after inadvertent dural puncture are reviewed.

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“…They have occurred following spinal surgery [1][2], long-and short-term intrathecal catheters [3][4][5][6][7][8][9][10][11], diagnostic and therapeutic lumbar punctures [12], combined spinal and epidurals (CSE) [13], epidural catheters [14][15][16][17][18][19][20], and one-shot epidural anesthetics and steroid injections [21][22][23]]. An overview of CSF-cutaneous fistula reports is presented in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous stitching of the outflow defect has been used [4,5,13,21]. Epidural blood patches have been reported to be successful [3,4,[6][7][8][9]11,12,14,16,20,21] even in cases of fistulas due to surgical defects [1,2]. Subcutaneous infiltration around the fistula with saline has been suggested [4].…”

Section: Discussionmentioning

confidence: 99%

Persistent cerebrospinal fluid-cutaneous fistula after epidural analgesia: a case report and review of literature

Tsai¹,

Ahmed²,

Wang³

2014

J Anesthesiol Clin Sci

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Presented is a case of persistent high-output cerebrospinal fluid (CSF) leak following epidural catheter removal on postoperative day 5 for a 64-year-old patient after exploratory laparotomy. Epidural catheter placement required multiple attempts preoperatively and was complicated by a "wet tap". Diagnosis of CSF leak was made with glucose, protein and beta-2 transferrin testing. In our review of 30 cases with reported CSF-cutaneous fistula, a trend towards requiring epidural blood patch for symptom relief exists when larger bore needles are used (all 9 reports involving 14 gauge or larger needles and 2 reports of fistulas resulting from a surgical defect) and duration of catheter stay is long. Notably, there were 3 case reports of CSF-cutaneous fistulas occurring without the placement of a catheter. Among 9 cases of fistula reported in the obstetric population, only one patient needed EBP for symptom control. Location of the needle/catheter insertion site at different levels of the neuraxium does not appear to affect the risk of developing a CSF-cutaneous fistula. CSF-cutaneous fistulas are a rare event that should be recognized early due to the potential for infections and neurologic complications. Glucose and protein testing offer a rapid but less specific means of diagnosing a possible CSF leak and can be used as guidance while awaiting results from beta-2 transferrin or beta-trace protein testing for definitive identification of CSF. With literature review, we propose an algorithm to help early detection and management of CSF-cutaneous fistula.

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Cerebrospinal fluid cutaneous fistula An unusual complication of epidural anaesthesia

Abstract: We describe two cases of cerebrospinaljuid-cutaneous$stula following epidural anaesthesia used for postoperative pain relieJ In each case spinal headache occurred only after removal of the catheters and both patients were treated successfully with autologous blood patches.

Cited by 19 publications

References 8 publications

Cerebrospinal Fluid Cutaneous Fistula after Uneventful Epidural Analgesia

Cerebrospinal Fluid Cutaneous Fistula after Uneventful Epidural Analgesia

Intermittent Cerebrospinal Leak After Inadvertent Dural Puncture During Epidural Catheter Placement for Postoperative Analgesia

Persistent cerebrospinal fluid-cutaneous fistula after epidural analgesia: a case report and review of literature

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