A novel technique of multiple-site epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia.
A novel technique of multiple-site epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia.
复制标题
多部位硬膜外血贴给药治疗脑脊液低血容量的新技术。
DOI：
10.3171/2012.1.jns111568
复制
发表时间：
2012
影响因子：
4.1
通讯作者：
A. Tanaka
中科院分区：
文献类型：
--
作者：
T. Ohtonari;S. Ota;N. Nishihara;T. Ota;Yasue Tanaka;Y. Sekihara;A. Tanaka
对象
硬膜外血液补片（EBP）是治疗CSF低血容量症的广泛接受的标准程序，特别是当通过脊柱MRI或CT脊髓造影（CTM）检测到硬膜外CSF泄漏时。然而，在相当多的情况下，泄漏的CSF沿着沿着脊髓硬膜外腔扩散到大面积上，使得外科医生难以清楚地识别真正的泄漏点。在这种情况下，自体血液可以在多个脊柱节段注入多个入口。在本文中，作者设计了一种新的多部位EBP方法，通过使用静脉导管作为连续输注的可滑动装置，具有单一的腰椎入口点。在这份报告中，他们介绍了这种新的，单入口，连续多部位EBP管理技术，并报告了他们获得的一些结果。
方法
通过硬膜外导管对5例自发性CSF低血容量症患者（3例男性和2例女性;平均年龄47.2岁，范围34-65岁）应用EBP。硬膜外CSF泄漏的检测基于MRI和/或CTM结果。然而，在所有情况下，泄漏地点都无法明确确定。这些患者的主要症状是复发性自发性慢性硬膜下血肿伴直立性头痛（3例）和单纯直立性头痛（2例）。所有患者均在血管造影床上俯卧位接受手术，并使用双平面透视进行准确操作。局部麻醉后，作者通过腰椎椎板间窗插入4 Fr短鞘管（血管造影标准），并将其置于背侧硬膜外腔。然后，他们通过鞘管引入了一根4.2 Fr直型导管，并沿35 G导丝向上沿着导航，导丝的头端向上移动超过检测到的CSF泄漏的头端。从每个患者的前臂上预先固定的静脉入口获得血液，并将其缓慢注入硬膜外导管。每次，作者都尝试将尽可能多的自体血液注入硬膜外腔，同时根据患者的疼痛表现逐渐向尾侧移动导管。
结果
3例慢性硬膜下血肿均预防了复发。1例患者直立性头痛完全消失，其余4例患者直立性头痛缓解。
结论
EBP的新应用方法为CSF血容量不足提供了一种有效的治疗选择，该方法借助静脉导管作为可滑动器械，可通过单个腰椎入口点将足量自体血液输注到多个硬膜外区域。
OBJECT
An epidural blood patch (EBP) is a widely accepted standard procedure to treat CSF hypovolemia, especially when the epidural CSF leak is detected by spinal MRI or CT myelography (CTM). In quite a few cases, however, the leaked CSF is spread over a large area along the spinal epidural space, making it difficult for the surgeon to clearly identify the true leakage points. In such cases, autologous blood can be infused at multiple spinal levels with multiple entries. In this paper, the authors have devised a new multiple-site EBP method with a single lumbar entry point by way of using an intravenous catheter as a slidable device for continuous infusion. In this report, they introduce this new, single-entry, continuous multiple-site EBP administration technique and report some of the results that they have obtained.
METHODS
An EBP was applied via an epidural catheter in 5 patients with spontaneous CSF hypovolemia (3 men and 2 women; mean age 47.2 years, range 34-65 years). The detection of an epidural CSF leak was based on MRI and/or CTM findings. In all cases, however, the leakage sites could not be identified clearly. The main symptoms of these patients were recurrent spontaneous chronic subdural hematoma with orthostatic headache (3 patients) and orthostatic headache only (2 patients). All patients underwent surgery in the prone position on an angiography table, and biplane fluoroscopy was used for accurate manipulation. After administration of a local anesthetic, the authors inserted a 4-Fr short sheath (which is standard in angiography) through the lumbar interlaminar window and placed it in the dorsal epidural space. They then introduced a 4.2-Fr straight catheter through the sheath and navigated it upward along a 35-gauge guidewire whose tip was moved upward beyond the cranial end of the detected CSF leakage. Blood was obtained from each patient from a previously secured venous entry on the forearm, and it was injected slowly into the epidural catheter. Each time, the authors tried to infuse as much autologous blood as possible into the epidural space, while moving the catheter gradually in the caudal direction in response to the patient's expression of pain.
RESULTS
In all 3 cases of chronic subdural hematoma, its recurrence was prevented. In 1 patient, the orthostatic headache disappeared completely, and it was relieved in the other 4 patients.
CONCLUSIONS
An efficient treatment option for CSF hypovolemia is provided by the new application method of EBP with the aid of an intravenous catheter as a slidable device, which enables infusion of a sufficient amount of autologous blood into multiple epidural areas with a single lumbar entry point.