Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland.
Neurocrit Care. 2012 Jun;16(3):444-9. doi: 10.1007/s12028-012-9702-4.
Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP.
This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits.
A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal epidural blood patching.
硬膜外血贴（EBP）是治疗自发性颅内低血压（SIH）或腰椎穿刺后头痛患者的一种治疗方法。有人提出，EBP 可能通过脑脊液（CSF）从椎管向颅内转移，直接封闭脊髓 CSF 瘘或导致颅内压（ICP）升高。据我们所知，这是首例 SIH 患者出现神经恶化且在脊髓 EBP 治疗前、中、后测量 ICP 的病例。
这位 52 岁的既往健康男性表现为全头痛。MRI 显示左半球硬脑膜下积液导致明显的占位效应。脊髓造影显示左侧 L-2 水平硬膜外有 CSF 漏，伴有硬膜外对比。为了封闭 CSF 漏，我们进行了硬膜外血贴（15 cc）治疗，并记录了 ICP。在应用硬膜外血贴（15 cc）后，患者迅速改善，但在治疗前、中、后 ICP 均无变化。治疗后 1 天，他的 GCS 评分从 12 分增加到 15 分，无头痛或神经功能缺损。
CSF 从椎管向颅腔转移，随后 ICP 升高，这可能不是脊髓硬膜外血贴的有益治疗机制。
