The efficacy and safety of lumbar accessed catheter-assisted epidural blood patch in cervical and thoracic cerebrospinal fluid leakage

Abstract

OBJECTIVE: To evaluate the clinical and radiological results of lumbar accessed catheter-assisted epidural blood patch (LACA-EBP) technique in treatment of sponta-neous intracranial hypotension secondary to cervico-thoracic cerebrospinal fluid leakage.METHODS: Patients presenting with spontaneous intra-cranial hypotension where magnetic resonance imaging cisternography confirmed and localized the cerebrospinal fluid leakage at cervicothoracic levels were treated with LACA-EBP. Visual analog scale (VAS) score for headache at baseline, third day after treatment, and during long-term follow-up was used to assess the treatment response. Posttreatment VAS score 53 on the third day defined treatment success, and VAS score double dagger 4 indicated treatment failure.RESULTS: LACA-EBP was performed in 10 patients (7 females, 3 males) with a mean age of 38.4 +/- 10.5 years. Orthostatic headache was the most common presenting symptom (10/10; 100%) followed by nausea (5/10; 50%). Pi-tuitary gland enlargement was the most commonly observed finding on pretreatment cranial magnetic reso-nance imaging (9/10; 90%). On magnetic resonance imaging cisternography, 8 patients had cervical and/or thoracic fistulas, whereas 2 patients had multiple-level fistulas. LACA-EBP was successful in all patients with no compli-cations. All patients showed a treatment response with a 72-hour VAS score 53. Follow-up VAS scores were avail-able for 8 patients with a clinical follow-up duration of 1- 74 months (median 7.5 months). During clinical follow-up, headache recurred in 2 patients.CONCLUSIONS: In our study cohort, LACA-EBP was a safe and efficacious technique in treatment of cerebro-spinal fluid leakage at cervical and thoracic levels.