Moriyama Eiji, Ishikawa Shinichi
Department of Neurosurgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
Department of Anesthesiology, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan.
NMC Case Rep J. 2022 Feb 23;9:1-5. doi: 10.2176/jns-nmc.2021-0265. eCollection 2022.
Spontaneous intracranial hypotension (SIH) is no longer considered rare. Its estimated annual incidence is 5 cases per 100,000 individuals, which is half the incidence of subarachnoid hemorrhage. Epidural blood patch (EBP) is indicated for SIH patients who do not improve with conservative treatment. Accurate determination of the cerebrospinal fluid (CSF) leak site is critical for a successfully targeted EBP. We report the case of a 43-year-old woman with SIH secondary to CSF leakage at the craniovertebral junction dural entry point of the vertebral artery (VA). We treated the patient 2 months after the onset of symptoms. Fat-suppressed T2-weighted spinal magnetic resonance (MR) images revealed a massive epidural fluid collection around the upper thoracic spine. Extravasation of contrast medium through the left VA-dural entry point was clearly visible on computed tomographic myelography. A cervical EBP was injected through the C1-2 interlaminar space. The patient had a smooth recovery and was asymptomatic, with normal spinal MR findings, 6 months after treatment. The possibility of CSF leakage from the dural entry point of the VA should be considered in SIH patients. EBP targeted at the VA entry point is proposed as a safe and effective treatment.
自发性颅内低压（SIH）不再被认为是罕见病。其估计年发病率为每10万人中有5例，这是蛛网膜下腔出血发病率的一半。硬膜外血贴（EBP）适用于经保守治疗无改善的SIH患者。准确确定脑脊液（CSF）漏出部位对于成功实施靶向EBP至关重要。我们报告了一例43岁女性患者，其SIH继发于椎动脉（VA）颅颈交界硬脑膜入口处的脑脊液漏。我们在症状出现2个月后对该患者进行了治疗。脂肪抑制T2加权脊柱磁共振（MR）图像显示上胸椎周围有大量硬膜外积液。在计算机断层脊髓造影上清晰可见造影剂通过左侧VA硬脑膜入口处外渗。通过C1-2椎间隙注射了颈椎EBP。治疗6个月后，患者恢复顺利且无症状，脊柱MR检查结果正常。SIH患者应考虑VA硬脑膜入口处脑脊液漏的可能性。建议将针对VA入口处的EBP作为一种安全有效的治疗方法。
