小漏洞会使大脑受损：靶向C1-C2修补术。
A Small Leak Will Sink the Brain: Targeted C1-C2 Patching.
作者信息
Decramer Thomas, Van Dyck-Lippens Pieter Jan, Franken Tom P, Demaerel Philippe, van Loon Johannes, Theys Tom
机构信息
Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium.
Department of Neurosurgery, University Hospitals Leuven, Belgium.
出版信息
World Neurosurg. 2017 May;101:816.e1-816.e3. doi: 10.1016/j.wneu.2017.02.086. Epub 2017 Feb 27.
BACKGROUND
Spontaneous intracranial hypotension syndrome results from spontaneous spinal cerebrospinal fluid (CSF) leaks. The first treatment of choice consists of lumbar epidural blood patching. If this fails, further imaging is mandatory to explore the possibility of targeted therapy.
CASE DESCRIPTION
We describe a case of a 50-year-old woman who developed spontaneous intracranial hypotension after minor blunt cervical trauma, complicated with bilateral subdural hematomas. Two lumbar epidural blood patches were unsuccessful. Magnetic resonance imaging with intrathecal gadolinium revealed a CSF leak at the C1-C2 level. A targeted blood patch via a percutaneous high thoracic epidural approach was performed, and symptoms disappeared in the immediate postoperative period with a regression of the subdural hematomas on subsequent imaging.
CONCLUSIONS
A targeted epidural blood patch using an epidural catheter represents an elegant approach to a CSF leak at the C1-C2 region and can be successful in treating patients with severe intracranial hypotension syndrome.
背景
自发性颅内低压综合征由自发性脊髓脑脊液（CSF）漏引起。首选的初始治疗方法是腰椎硬膜外血贴疗法。如果该方法失败，则必须进一步进行影像学检查以探究靶向治疗的可能性。
病例描述
我们描述了一例50岁女性，在轻度钝性颈部创伤后发生自发性颅内低压，并并发双侧硬膜下血肿。两次腰椎硬膜外血贴疗法均未成功。鞘内注射钆的磁共振成像显示C1-C2水平存在脑脊液漏。通过经皮高位胸椎硬膜外途径进行了靶向血贴治疗，术后症状立即消失，随后的影像学检查显示硬膜下血肿消退。
结论
使用硬膜外导管进行靶向硬膜外血贴是治疗C1-C2区域脑脊液漏的一种有效方法，并且可以成功治疗重症颅内低压综合征患者。
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