Direct consequences from a dural tear include headache, meningeal pseudocyst formation, or dural cutaneous fistulas leading to arachnoiditis, delayed wound healing, or a wound infection. These range from acute compression of thecal sac due to increased hydrostatic pressure, to dural tamponade by blood clot that permanently seals the dural tear. Previous studies have found audiometric deterioration following adp. Spontaneous dural tear leading to intracranial hypotension. The result demonstrated that dural tear could cause a series of inflammatory reaction in the spinal cord and further impair its sensory conduction function. Treatment of cerebrospinal fluid leak after spine surgery.
One possible way to reduce your risk of having a tear is to see if you are a candidate for a minimally invasive procedure. Occult cervical c12 dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch case report as o k u m a r bu v a n e n d r a n, m. Epidural blood patch inpatient care what you need to know. An epidural blood patch is a procedure in which your own blood is injected into the epidural space in your lower back in order to close tears in the dura, a thin membrane that surrounds the brain and spinal cord. Results indicate that this treatment approach is a viable option for people who experience post dural puncture headaches. Nerve injury, spinal fluid leak and meningitis are all possible complications of a dural tear. When blood patches dont work and there is a target for glue, the glue works by sealing the leak. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Epidural blood patch can cause acute neurologic deterioration.
This treatment option offers anesthesiologists the opportunity to minimize further patient harm and increased cost associated with dural tears. In their 2017 study, chinese researchers assert that dural sac tears can lead to cerebrospinal fluid leakage. Repair usually involves an epidural blood patch or sutures. Although accidental dural puncture and postdural puncture headache pdph are on the radar of most anesthesiologists administering epidural analgesia, subsequent hearing loss is often overlooked. The dorsal epidural blood patch is a commonly used management technique for spontaneous intracranial hypotension from a dural csf leak, but it may be less efficacious for cervical or ventral leaks. We report a case of a 54yearold man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid csf leakage into the lumbosacral area after spine surgery. You diagnosed me with dural tears after a car accident. Dural sac tears during spinal surgery verywell health.
Preventing dural tears during spine surgery expert mn. Epidural blood patch technique, recovery, and success rate. An inadvertent dural puncture results in the leakage of cerebrospinal fluid csf through the dural tear into the epidural space. A patients mri with postural symptoms demonstrated. Epidural blood patch an overview sciencedirect topics. Youll choose from these 3 codes when your surgeon does a repair of the dura in the spine to contain a cerebrospinal fluid csf leak. The procedure can be used to relieve post dural puncture headaches caused. Dura mater can also become punctured from minor trauma such as a tumble and dural tears are more common 25x in young females dural integrity may possibly be hormone related.
Incidental tear of the dural sac and cerebrospinal fluid leak is an unfortunate but real complication during lumbar spinal surgery that must be treated by surgeons intraoperatively and postoperatively. With the use of a blood patch to treat a dural tear, the anesthesia team was able to prevent a second reoperation. Levels of initial dural puncture and epidural blood patches. Dural tears can occur due to acute injury if disc material rubs or tears the dural mater.
I had kaiser insurance at the time and they neither believed you nor wanted to treat it. I had complications during the surgery and lost 6liters of blood, ive been experiencing mild to sever headaches usually when i stand for a amount of time or sit or even turn the wrong way, i have been. Lumbar epidural blood patch via a caudal catheter after. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Effectiveness of epidural blood patch in the management of. Full text targeted epidural blood patches under fluoroscopic. Epidural blood patch is a widely used technique to treat spinal headache and.
The vertebral space where the ebp was performed is depicted in figure 2. Caudal epidural blood patch for treating intractable vomiting in a child after placement of a permanent intrathecal catheter. Arachnoiditis spine center atlanta orthopedic spine. The epidural needle is placed in epidural space at the level where the spinal leakage is suspected. Epidural blood patch the high success rate 6890% after. Lumbar and thoracic epidural blood injections to treat. Epidural autologus blood patch was administered at the leakage site leading to significant improvement. Lumbar and thoracic epidural blood injections to treat spontaneous intracranial hypotension. A dural tear is a complication of spine surgery in which the thin covering over the spinal cord called dura mater is nicked by the surgeons instrument.
An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. Dural tears represent a serious challenge for the spine surgeon as well as the patient. Longterm effects of accidental dural puncture in patients. Accidental dural puncture adp during placement of an epidural catheter for anesthesia and analgesia is a well known complication. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Because the lesion dural tear might be located at the level of l5s1 according to statement of surgeon, we performed caudal epidural autologous blood patch to. Spontaneous dural tear leading to intracranial hypotension and tonsillar herniation. Treatment with epidural blood patch for iatrogenic. Research has also repeatedly indicated that an epidural blood patch is a. Headaches due to low csf pressure are stereotypically orthostatic in character with exacerbation in the upright position and relative improvement while supine. However, they are much more common during surgery, especially if its not the first time this area of your spine is being operated on.
They treated a 36yearold female with chiropractic manipulation following which she developed severe orthostatic headaches, nausea, and vomiting. To our best knowledge, this approach has not been reported. This technique is known as epidural blood patch and is highly successful in the treatment of postdural puncture headache. Evaluation and treatment of dural tears in lumbar spine. A recentlypublished study showed that blood patches can help. Comparison of dural repair techniques sciencedirect. With blood patches, we really do not need to know where the leak is. Leaking dural defects have also been noted during surgery after protracted periods of time have passed following lumbar puncture. If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. Repair with autologous fascia could attenuate neuroinflammation and help to maintain normal sensory conduction function. Theres a risk of a dural tear occurring during all types of spinal surgery, including lumbar decompression surgery. Feasibility of placement of an anterior cervical epidural.
Yet, hearing impairment is a common occurrence following pdph, but one that can be improved by applying an epidural blood patch. Epidural blood patch ebp is a common method for treating postural headache in patients with accidental dural puncture. To put the blood patch in place, the anesthesiologist will. Healing of dural after lumbar puncture and blood patch.
We report the technique of placing an anterior cervical blood patch for a large cervical ventral leak. However, dural tears in the cervical region may be more difficult to treat. This loss of csf may result in a headache due to the loss of the. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. In fact, it has been suggested that while increased pressure around the thecal sac may help alleviate the headache immediately after the blood patch is performed, this relief would be. Blood patch minor postdural puncture headache are treated with blood patch treatment. What i will not go into detail about preventing postspinal pdph with small gauge, noncutting needles preventing accidental unintentional dural.
Epidural blood patch has better rate of working blood patches are generally thought to be relatively safe, but occasional reports of increased csf pressure, persistent epidural fluid collections, nerve damage and infection have been reported. Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Fibrin glue can be applied in much the same way as a blood patch to seal a known spinal csf leak site. After 5 years in the kaiser system i finally got out and came back to you. The goal of the epidural blood patch is to treat the symptoms, typically headache, related to cerebrospinal fluid leaks of any cause. We present a case of intracranial hypotension secondary to a spontaneous dural tear in an adult patient with marfan syndrome. Effectiveness of epidural blood patch in the management of post dural puncture headache. Low csf pressure headache is divided by the international headache society into three categories. An epidural blood patch may also help reduce other spinal fluid leak symptoms. The proposed mechanisms of headache in sih include csf leakage through a small dural tear, reduced production of csf, or hyperabsorption of csf.
Appropriately coding these dural tear procedures will depend on whether the operative note indicates that the surgeon performed a laminectomy and what graft was used for the repair. Cervical dural csf leak on mri and ct treated by blood patch. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Dural tears and spinal fluid leaks the burton report. If you have a csf leak it may cause one or more of the following symptoms. Headaches which may get worse when you are standing and feel better when you lay down. Dural tear is a known complication of spinal surgeries, such as laminectomies, spinal fusions, and disc excisions. Hearing loss from dural puncture not uncommon, but is. How to increase healing of dura mater after lumbar. If blood patches alone do not succeed in closing the dural tears, placement of percutaneous fibrin glue can be used in place of blood patching, raising the effectiveness of forming a. Treatment for dural tears, including blood patches, can also lead to arachnoiditis if the blood patch was injected too deep in the dural mater.
A volume of 12 to 18 ml of autologous blood is injected slowly into the epidural space at the level of dural puncture under strict aseptic precautions. Longterm effects of accidental dural puncture in patients having. They can lead to a significant decrease in the duration and intensity of headaches. Inadvertent dural puncturewet tap and pdph management. Treatment may include conservative therapy and operation. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Fluoroscopyguided caudal epidural blood patch for relieving post. The risk of developing a blood clot can be significantly reduced by staying active during your recovery or wearing compression stockings to help improve your blood flow.
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