Ventral Spontaneous Durotomy Following Vaginal Delivery

Abstract Introduction Dural breaches have a diverse etiology, including spontaneous rupture and trauma. Most cases resolve with bedrest, though in refractory cases an epidural blood patch can be placed to obstruct further leakage. Here, we discuss a unique case of a spontaneous ventral durotomy foll...

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Bibliographic Details
Published in:World neurosurgery 2017-06, Vol.102, p.697.e5-697.e7
Main Authors: Agarwal, Nitin, M.D, Kashkoush, Ahmed I., B.S, Prabhu, Arpan V., B.S, Sekula, Raymond F., M.D., M.B.A
Format: Article
Language:English
Subjects:
Adult
Cerebrospinal fluid leak
Cerebrospinal Fluid Leak - etiology
Cerebrospinal Fluid Leak - surgery
Delivery
Dura Mater
Female
Headache Disorders - etiology
Hematoma, Subdural, Acute - etiology
Hematoma, Subdural, Acute - surgery
Humans
Intracranial hypotension
Intracranial Hypotension - etiology
Intracranial Hypotension - surgery
Neurosurgery
Obstetric Labor Complications - etiology
Obstetric Labor Complications - surgery
Pregnancy
Puerperal Disorders - etiology
Puerperal Disorders - surgery
Rupture, Spontaneous - etiology
Rupture, Spontaneous - surgery
Spontaneous durotomy
Surgical Flaps
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Summary:Abstract Introduction Dural breaches have a diverse etiology, including spontaneous rupture and trauma. Most cases resolve with bedrest, though in refractory cases an epidural blood patch can be placed to obstruct further leakage. Here, we discuss a unique case of a spontaneous ventral durotomy following vaginal delivery managed with injections of autologous blood through bilateral transforaminal needles. Clinical Presentation A previously healthy 36-year-old pregnant female presented to the inpatient maternity ward with positional occipital headaches and neck pain 24 hours following normal spontaneous vaginal delivery. Two dorsally placed epidural blood patches provided only transient relief. Ultimately, computed tomography (CT) myelogram reveal ventral cerebrospinal fluid leak. CT-guided blood patch placement ventrally was utilized to provide targeted therapy. Conclusion Spontaneous durotomy is a rare phenomenon and should be considered in patients that present with positional headaches. Ventrally targeted therapy via epidural blood patch should be considered to provide optimal relief.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2017.01.133