Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension
Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension
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DOI：
10.3174/ajnr.a3945
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发表时间：
2014-09-01
影响因子：
3.5
通讯作者：
Pandey, A. S.
中科院分区：
文献类型：
--
作者：
Griauzde, J.;Gemmete, J. J.;Pandey, A. S.
背景和目的：自发性低颅压对治疗医生来说是一个治疗挑战。在这项研究中，我们提出了我们的经验与管理的大容量血液补丁多个网站在硬膜外腔通过一个单一的导管接入site.MATERIALS和METHODS：一项回顾性研究进行了自发性颅内低血压的患者进行了大容量血液补丁多个网站在硬膜外腔通过一个单一的导管接入网站从2010年至2012年。患者的人口统计学数据，临床图表，治疗适应症，影像学图像，程序说明，并postprocedure hospital course were reviewed.RESULTS：总体而言，9例患者进行了20血液补丁程序。选择患者接受大容量手术，因为他们有一个失败的定位硬膜外血液补片或如果成像显示多个可能的泄漏部位。其中女性6例，男性3例，平均年龄33.5岁。每次手术的平均血液注射量为54.1 mL（中位数= 55 mL;范围= 38-70 mL）。所有患者都有直立性头痛作为他们的症状之一; 22%的患者还表现出神经认知能力下降和行为改变; 89%的患者症状得到改善或解决; 80%的患者既往使用过定位硬膜外血液或纤维蛋白胶贴片失败，但使用了大容量导管定位血液贴片后得到改善。我们的经验支持通过单导管穿刺部位在硬膜外腔的多个部位使用大容量血液补片治疗自发性颅内低血压。此外，我们的研究结果表明，该程序在难治性自发性低颅压病例中的作用。
BACKGROUND AND PURPOSE: Spontaneous intracranial hypotension can be a therapeutic challenge to the treating physician. In this study, we present our experience with the administration of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site.MATERIALS AND METHODS: A retrospective review was conducted of patients with spontaneous intracranial hypotension who underwent a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site from 2010 to 2012. Patient demographic data, clinical charts, indications for treatment, radiographic images, procedure notes, and postprocedure hospital course were reviewed.RESULTS: Overall, 9 patients were identified who underwent 20 blood patch procedures. Patients were selected to undergo the large-volume procedure either because they had a failed site-directed epidural blood patch or if imaging demonstrated multiple possible leak sites. There were 6 women and 3 men, with an average age of 33.5 years. The mean volume of blood injected per procedure was 54.1 mL (median = 55 mL; range = 38-70 mL). All patients had an orthostatic headache as one of their presenting symptoms; 22% also presented with neurocognitive decline and behavioral changes; 89% of patients had improvement or resolution of their symptoms; and 80% of patients who had a previously failed site-directed epidural blood or fibrin glue patch improved with a large volume catheter-directed blood patch.CONCLUSIONS: Our experience supports the use of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for the treatment of spontaneous intracranial hypotension. Additionally, our results indicate a role for this procedure in refractory cases of spontaneous intracranial hypotension.