Michelangeli F, Feyler C, Donsa E, Carlon M, Maestracci P
Ann Anesthesiol Fr. 1978;19(6):497-537.
The authors propose a pathogenic classification of perforations of the dura mater occurring during continuous epidural anaesthesia: according to the flow through the communication with the subarochnoid space. Two clinical forms of anaesthesia affecting the cord itself may be distinguished on this basis, one frequent and of immediate onset, diagnosed by the "test dose" and the other rare, of delayed onset, where this safety measure does not suffice. Routine prior epidurography is suggested, in order to ensure the diagnosis of dura mater perforation. In the case of the latter, it show either a more or less typical appearance of radicolography only or, more rarely, a picture which combines opacification of the epidural space with the subarachnoid passage of the contrast medium. This "mixed" appearance, although rare, should be known since it makes it possible to prevent delayed total spinal anaesthesia.
根据与蛛网膜下腔相通处的液体流动情况。基于此可区分出两种影响脊髓本身的麻醉临床形式，一种常见且起病迅速，可通过“试验剂量”诊断，另一种罕见且起病延迟，此时这种安全措施并不足够。建议进行常规硬膜外造影，以确保诊断硬脑膜穿孔。对于后者，它要么仅显示或多或少典型的放射影像学表现，要么更罕见地显示一种将硬膜外腔造影剂充盈与造影剂蛛网膜下腔通过相结合的影像。这种“混合”表现虽然罕见，但应为人所知，因为它有助于预防延迟性全脊髓麻醉。
