Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

Kim, Sae Young; Hong, Ji Hee

doi:10.3344/kjp.2010.23.1.46

Cited by 22 publications

(25 citation statements)

References 17 publications

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“…In the paper, the authors described that they found only one case report where a patient (after identification of CSF leakages) was successfully managed by injecting an EBP under fluoroscopic guidance at the upper cervical and at the middle thoracic level. 2 By citing only this report, however, they overlooked the case description by Feltracco et al 3 who in 2010 reported on: simultaneous EBPs at different intervertebral spaces for SIH.…”

Section: Sirmentioning

confidence: 87%

“…We referred in the paper the infrequent use of a double simultaneous EBP for treatment of SIH and the only find by the authors of a case report where this procedure was performed. 2 In that case, they identified cerebrospinal fluid (CSF) leakage (by radionuclide cisternography) at the upper cervical level and at the middle thoracic level, and the patient was successfully managed by injecting the EBP at each level of leakage at the same time. 2 Likewise, we admit we could have overlooked to cite the case reported by Feltracco et al, 3 who described 3 years ago their experience on blind simultaneous EBP.…”

Section: Sirmentioning

confidence: 99%

“…2 In that case, they identified cerebrospinal fluid (CSF) leakage (by radionuclide cisternography) at the upper cervical level and at the middle thoracic level, and the patient was successfully managed by injecting the EBP at each level of leakage at the same time. 2 Likewise, we admit we could have overlooked to cite the case reported by Feltracco et al, 3 who described 3 years ago their experience on blind simultaneous EBP. These authors reported a double simultaneous EBP at different intervertebral spaces (T12-L1 and T6-T7) as treatment for a patient with SIH.…”

Section: Sirmentioning

confidence: 99%

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Feltracco¹,

Ori²

2013

Acta Anaesthesiol Scand

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Sir,We have read the article by J. M. Beleña et al 1 who report on a patient with spontaneous intracranial hypotension (SIH) treated with a double epidural blood patch (EBP) at two different levels (lumbar and thoracic) in the same procedure. This double EBP was carried out on a 34-year-old woman with a 3-month history of severe fronto-occipital headaches and a history of two epidurals 3 and 4 years prior. The patient had no abnormalities at neuroimaging studies, and no detection of cerebrospinal fluid (CFS) leakage at radionuclide cisternography. With the patient in sitting position, a lumbar epidural puncture was performed, and 15 ml of blood were injected epidurally; a second EBP at T10-T11 level was consecutively carried out.They reported that two 'blind' EBPs were attempted, considering that, as the majority of spontaneous leaks occur at the thoracic level, a double EBP could have offered a higher probability of success because of the more extensive area covered.In the paper, the authors described that they found only one case report where a patient (after identification of CSF leakages) was successfully managed by injecting an EBP under fluoroscopic guidance at the upper cervical and at the middle thoracic level. 2 By citing only this report, however, they overlooked the case description by Feltracco et al 3 who in 2010 reported on: simultaneous EBPs at different intervertebral spaces for SIH.Beleña et al 1 affirm that based on reported experience of other authors a double EBP would ensure the success of the treatment, but no reference is made to our previous description of a 'blind' T12-L1 epidural puncture immediately associated with a second at T6-T7, and with 15 ml of autologous blood injected at each level. Some similarities with what we explained both in the technique as well as in the case description may be recognised on careful reading. Our first comment was as follows: 'two simultaneous epidurals may lead to a more complete dural tamponade and better sealing in the upper cervical meninges. Injection at two separate sites may decrease the possibility of spinal compression from a large amount of blood and guarantee a more uniform distribution over the meninges, and . . . a two-level epidural blood patch may be an option to extend the distribution of blood when the exact CSF leak site is unknown'. In a certain manner this recurs in Beleña's comment, which reports: we tried to combine the effectiveness of the puncture at two different levels at the same time to improve the results of the technique (more extensive area covered), and to minimise the risk of spinal compression (a smaller amount of blood needed), and . . . simultaneous use of two EBPs could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage.Being that the execution of a simultaneous double EBP is not a common procedure for treatment of SIH, it would have been appropriate and deserved to cite one of the first experiences on blind simultaneous EBPs. P. Feltracco C. Ori References 1. Beleña JM, Nuñez M,...

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Section: Sirmentioning

confidence: 87%

Section: Sirmentioning

confidence: 99%

Section: Sirmentioning

confidence: 99%

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Feltracco¹,

Ori²

2013

Acta Anaesthesiol Scand

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“…To treat refractory cases of SIH, an epidural blood patch (EBP) is a very effective treatment modality. [9][10][11][12][13] Although a targeted EBP seems to be effective, 14,15 some patients need repeated blood patches because of inadequate control of their postural headache. Curious about the reason for the unresponsiveness to the EBP in such patients, we aimed in this study to find the relationship between EBP responses and cisternographic findings, hypothesizing that the number of EBPs would increase if the number of CSF leakage levels in RI cisternography increased.…”

mentioning

confidence: 99%

Retrospective Study of Epidural Blood Patch Use for Spontaneous Intracranial Hypotension

Joo

Hwang²,

Kong

et al. 2015

Regional Anesthesia and Pain Medicine

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“…Conservative therapy includes bed rest, hydration and administration of caffeine or steroids . When conservative measures fail, the use of autologous epidural blood patches (EBP) is recommended . Because of the use of a single EBP does not relieve the symptoms in a variable percentage of patients, some of them require 2 or 3 ones .…”

mentioning

confidence: 99%

Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch

Beleña

Núñez

Yuste

et al. 2012

Acta Anaesthesiol Scand

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Spontaneous intracranial hypotension (SIH) is considered to be a very rare disease. It is characterised by an orthostatic headache in the absence of a past history of a trauma or a dural puncture. SIH is caused by a spontaneous spinal cerebrospinal fluid (CSF) leakage demonstrated by neuroradiological studies in most of the patients. Conservative treatment usually includes bed rest, hydration and administration of caffeine or steroids. However, when the patient is refractory to the conservative treatment, an epidural blood patch (EBP) is performed. We report a 34-year-old woman with SIH and no neuroradiologically demonstrable clear point of CSF leakage, who was treated with a double EBP at two different levels (lumbar and thoracic) in the same procedure. The patient was successfully managed, and she was still asymptomatic at the 18 months follow-up. After review of literature, we observed that execution of a double EBP at the same time is not a common procedure for treatment of SIH. We consider that simultaneous use of two EBP could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage.

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Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

Cited by 22 publications

References 17 publications

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Retrospective Study of Epidural Blood Patch Use for Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch

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