Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak: a case report

Background Epidural blood patch (EBP) is a recognized treatment for spontaneous cerebrospinal fluid leak (SCFL) and is typically administered by the interlaminar approach. Here, we report a case of a patient in whom SCFL failed to resolve after three applications of interlaminar EBPs before finally...

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Bibliographic Details
Published in:JA clinical reports 2017-01, Vol.3 (1), p.2-2, Article 2
Main Authors: Fujiwara, Aki, Watanabe, Keisuke, Hashizume, Keiji, Shinohara, Kozue, Fukumoto, Michiko, Kimoto, Katsuhiro, Kawaguchi, Masahiko
Format: Article
Language:English
Subjects:
Anesthesiology
Animal behavior
Case Report
Case reports
Critical Care Medicine
Dynamic myelography
Emergency Medicine
Epidural
Intensive
Medicine
Medicine & Public Health
Pain Medicine
Spontaneous cerebrospinal fluid leak
Transforaminal epidural blood patch
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Summary:Background Epidural blood patch (EBP) is a recognized treatment for spontaneous cerebrospinal fluid leak (SCFL) and is typically administered by the interlaminar approach. Here, we report a case of a patient in whom SCFL failed to resolve after three applications of interlaminar EBPs before finally being successfully treated with transforaminal EBP. Case presentation We report a case of a 41-year-old female with a definitive diagnosis of SCFL according to computed tomography (CT) myelography. A fluoroscopy-guided interlaminar EBP was applied three times without resolution of her orthostatic headache. A second myelography was therefore performed demonstrating a leak point on the ventral side of the dura mater. To close the ruptured ventral dura mater, it was necessary to fill the ventral epidural space with blood. Therefore, transforaminal EBP was performed. On spinal CT performed immediately after treatment, the ventral epidural space was observed to be filled with injected blood. Her headache improved the following day, and her symptoms completely subsided after 5 days. Conclusion Transforaminal epidural blood patch is appropriate for patients with intractable cerebrospinal fluid leak. Patients with cerebrospinal fluid leakage due to rupture of the ventral side of the dura mater may be particularly good candidates for this procedure.
ISSN:2363-9024
2363-9024
DOI:10.1186/s40981-016-0073-2