Department of Anesthesiology, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Int J Obstet Anesth. 2012 Apr;21(2):192-4. doi: 10.1016/j.ijoa.2011.12.003. Epub 2012 Feb 10.
Idiopathic intracranial hypertension is a condition consisting of increased intracranial pressure of unknown etiology, predominantly affecting obese women of childbearing age. Symptomatic relief can be provided by lumbar puncture and withdrawal of cerebrospinal fluid, and the technique has been described in laboring women using an intrathecal catheter. We present two patients who achieved both labor analgesia and symptomatic relief via a combined spinal-epidural technique with small volume cerebrospinal fluid withdrawal. Both women complained of headache of at least a 5 on a 10-point pain scale at the time of labor induction. Between 5 and 6 mL of cerebrospinal fluid were withdrawn at the time of combined spinal-epidural insertion and pain relief was successfully achieved with patient-controlled epidural anesthesia. One patient proceeded to cesarean delivery for fetal indications under epidural anesthesia. Both women described significant improvement in headache symptoms that persisted until discharge from hospital, and neither developed new neurologic symptoms. A combined spinal-epidural technique with a small volume of cerebrospinal fluid withdrawal may provide labor analgesia and symptomatic relief in the parturient with idiopathic intracranial hypertension.
特发性颅内高压是一种由未知病因引起的颅内压升高的疾病，主要影响生育年龄的肥胖女性。腰椎穿刺和脑脊液抽取可以缓解症状，这项技术已经在使用鞘内导管的分娩妇女中得到描述。我们介绍了两名通过小容量脑脊液抽取的联合腰麻-硬膜外技术实现分娩镇痛和症状缓解的患者。两名女性在分娩诱导时的疼痛评分至少为 10 分中的 5 分。在联合腰麻-硬膜外穿刺时抽取了 5 至 6 毫升脑脊液，患者自控硬膜外麻醉成功缓解了疼痛。一名患者因胎儿指征行剖宫产术，在硬膜外麻醉下进行。两名女性均描述头痛症状显著改善，直到出院时仍持续存在，且均未出现新的神经症状。在特发性颅内高压产妇中，小容量脑脊液抽取的联合腰麻-硬膜外技术可能提供分娩镇痛和症状缓解。
