Kwon So-Young, Kim Yong-Shin, Han Sung-Min
Department of Anesthesiology and Pain Medicine, St. Vincent Hospital, Catholic University of Korea; Department of Anesthesiology and Pain Medicine, St. Mary's Hospital, Catholic University of Korea.
Pain Physician. 2014 May-Jun;17(3):E381-4.
A 39-year-old woman with no history of trauma or meningitis presented to the neurology department of our hospital with an occipital headache, neck pain, nausea, and dizziness that had worsened during the previous month. The headache worsened when sitting or standing and partially regressed when lying down. She was diagnosed with spontaneous intracranial hypotension (SIH) and received conservative management. After failing to respond to conservative management, she underwent an autologous epidural blood patch (EBP) at the T7-8 level. The headache and associated symptoms did not improve after the procedure. Magnetic resonance (MR) myelography suggested a cerebrospinal fluid leakage at the C1-2 level resulting in intracranial hypotension. An 18-gauge Tuohy needle was inserted at the T1-2 interlaminal level using a paramedian approach under fluoroscopic guidance. The cervical epidural Racz catheter was threaded through the Tuohy needle up to the cervical spine and the catheter tip was confirmed to be at the right cervical 1-2 site on an anteroposterior (AP) view. Five mL of autologous blood was injected into the epidural space through the cervical epidural Racz catheter. Her occipital headache and associated symptoms gradually disappeared after the procedure. Seven days later the headache was largely resolved and she was discharged. Follow-up magnetic resonance imaging (MRI) showed the disappearance of abnormal radiological features associated with intracranial hypotension. She currently remains symptom free for 9 months. Delivery of autologous blood patch via a cervical epidural Racz catheter inserted from the upper thoracic spine can be a safe and effective method for patients with SIH due to cerebrospinal fluid (CSF) leakage in the upper cervical spine.
一名39岁女性，无创伤或脑膜炎病史，因枕部头痛、颈部疼痛、恶心和头晕来我院神经科就诊，这些症状在前一个月有所加重。头痛在坐立或站立时加重，躺下时部分缓解。她被诊断为自发性颅内低压（SIH）并接受了保守治疗。保守治疗无效后，她在T7 - 8水平接受了自体硬膜外血贴（EBP）治疗。术后头痛及相关症状并未改善。磁共振（MR）脊髓造影显示C1 - 2水平脑脊液漏导致颅内低压。在透视引导下采用旁正中入路，于T1 - 2椎板间隙水平插入一根18号Tuohy针。将颈段硬膜外Racz导管经Tuohy针穿入至颈椎，在前后位（AP）视图上确认导管尖端位于右侧颈1 - 2部位。通过颈段硬膜外Racz导管向硬膜外间隙注入5 mL自体血。术后她的枕部头痛及相关症状逐渐消失。7天后头痛基本缓解，她出院了。随访磁共振成像（MRI）显示与颅内低压相关的异常影像学特征消失。她目前9个月无症状。通过从胸椎上段插入的颈段硬膜外Racz导管进行自体血贴，对于因上颈椎脑脊液（CSF）漏导致SIH的患者可能是一种安全有效的方法。
