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Category: Volume 10 Issue 03 March 2022
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Title: Epidural Blood Patch under Local Anaesthesia for Spontaneous Intracranial Hypotension: A Single Institute Experience

Authors: Dr Pratima Kothare, Dr Dipti Madan

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.28

Abstract

Spontaneous Intracranial hypotension is an uncommon benign condition that occurs due to cerebrospinal fluid leakage leading to low CSF pressures. Orthostatic headache is the most common distressing symptom. The aim of treating spontaneous intracranial hypotension (SIH) is to stop the CSF leak. SIH needs to be addressed in a timely manner, as the symptoms are disturbing, and also because the most common complication is subdural hematoma which could be potentially life threatening.

Materials and Method: We reviewed 12 cases from August 2015 to August 2021 of SIH in our institute. All cases were conducted by lumbar interlaminar approach, under fluoroscopic guidance. Results were shown as numbers (n) and percentage (%).

Epidural space was detected with loss of resistance technique in lateral position in L3-L4 space with a 16 gauge Tuohy needle, and a catheter introduced cranially as high as possible, but not necessarily at the leak site. 2cc Iohexol dye with 5 cc saline was then injected and epidural placement of catheter and spread of dye was confirmed. Thereafter, 15 cc of venous blood was withdrawn and injected immediately under fluoroscopic guidance. Catheter was then withdrawn and the head-low position given for at least thirty minutes. The patient was then shifted to the ward with instructions for strict bed rest for 24 hours.

Observation: All cases had a single successful epidural puncture attempt. No adverse hemodynamic events occurred. No Motor block of lower limbs or worsening of headache occurred.

Results: 83.33% had satisfactory relief of headache. 8.33% required surgery for repair of leak, this was observed in the post lumbar laminectomy patient, while 8.33% required repeat of epidural blood 3 times within a span of 3 months due to no significant relief of headache.

Conclusion: The interlaminar approach under local anesthesia for EBP is an easy and effective treatment modality for SIH for relief of pain.

The epidural blood patch seals the CSF leak, thereby improving the pressure and causing relief of symptoms. An epidural blood patch can be repeated if symptoms are not relieved as the complication rate is very low.

Keywords: epidural blood patch, spontaneous intracranial hypotension.

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Corresponding Author

Dr Dipti Madan

Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai 400020