Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic? This is the question

Liu

Journal of Biophotonics

et al. 2019

Needle placement is important for many clinical interventions, such as tissue biopsy, regional anesthesia and drug delivery. It is essential to visualize the spatial position of the needle and the target tissue during the interventions using appropriate imaging techniques. Based on the contrast of optical absorption, photoacoustic imaging is well suited for the guidance of interventional procedures. However, conventional photoacoustic imaging typically provides two‐dimensional (2D) slices of the region of interest and could only visualize the needle and the target when they are within the imaging plane of the probe at the same time. This requires great alignment skill and effort. To ease this problem, we developed a 3D interventional photoacoustic imaging technique by fast scanning a linear array ultrasound probe and stitching acquired image slices. in vivo sentinel lymph node biopsy experiment shows that the technique could precisely locate a needle and a sentinel lymph node in a tissue volume while a perfusion experiment demonstrates that the technique could visualize the 3D distribution of injected methylene blue dye underneath the skin at high temporal and spatial resolution. The proposed technique provides a practical way for photoacoustic image‐guided interventions.

Section: Introductionmentioning

confidence: 99%

Three‐dimensional interventional photoacoustic imaging for biopsy needle guidance with a linear array transducer

Liu

Journal of Biophotonics

et al. 2019

“…Injection of blood into the epidural space causes a mass effect, reduction in epidural space compliance and results in cephalad CSF shift. This has been demonstrated by MRI, where the haematoma caused thecal sac and nerve root compression 17…”

Section: Discussionmentioning

confidence: 92%

Intrathecal haematoma after an epidural blood patch

Ito

Bhagwat

2022

BMJ Case Rep

SummaryThis case demonstrates a rare but potentially serious complication of an epidural blood patch (EBP). Intrathecal haematoma is a rare complication after an EBP and anaesthetists should be able to promptly identify and manage these patients to prevent long-term damage. This case also highlights the importance of informed consent according to the principles of the Montgomery judgement/principle of consent.

“…In a 2003 porcine study, Boezaart 30 immediate and significant increase in cerebral cortical blood flow. This, in turn, was immediately reversed by distant lumbar EBP-iatrogenic peridural hematoma 31 -which is known as an early and potent stimulus for cerebral vasoconstriction. 32 While vasodilation (in the case of PDPH, based on the Monro-Kellie hypothesis 33 ), and inflammation, most likely due to the cortical vasodilatation or some trigeminal reflex, are probably shared features in some PHDs and PDPH, we recognize that these conditions' specific etiology, triggers, and pathophysiological mechanisms differ.…”

Section: Discussionmentioning

confidence: 99%

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

Boezaart,

Smith,

Zasimovich

et al. 2023

Reg Anesth Pain Med

In 1981, Devoghel achieved an 85.6% success rate in treating patients with treatment-refractory cluster headaches with alcoholization of the pterygopalatine ganglion (PPG) via the percutaneous suprazygomatic approach. Devoghel’s study led to the theory that interrupting the parasympathetic pathway by blocking its transduction at the PPG could prevent or treat symptoms related to primary headache disorders (PHDs). Furthermore, non-invasive vagus nerve stimulation (nVNS) has proven to treat PHDs and has been approved by national regulatory bodies to treat, among others, cluster headaches and migraines.In this case series, nine desperate patients who presented with 11 longstanding treatment-refractory primary headache disorders and epidural blood patch–resistant postdural puncture headache (PDPH) received ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks (PPGB), and seven also received nVNS. The patients were randomly selected and were not part of a research study. They experienced dramatic, immediate, satisfactory, and apparently lasting symptom resolution (at the time of the writing of this report). The report provides the case descriptions, briefly reviews the trigeminovascular and neurogenic inflammatory theories of the pathophysiology, outlines aspects of these PPGB and nVNS interventions, and argues for adopting this treatment regime as a first-line or second-line treatment rather than desperate last-line treatment of PDPH and PHDs.