Phan Amy, Shah Shalin, Joo Peter, Mesfin Addisu
University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
World Neurosurg. 2022 Aug;164:e877-e883. doi: 10.1016/j.wneu.2022.05.060. Epub 2022 May 20.
Incidental durotomies resulting in symptomatic postoperative cerebrospinal fluid (CSF) leaks can be treated with bedrest, subarachnoid lumbar drain, and surgical re-exploration. Another option is an epidural blood patch, which forms a clot over the dural tear in a minimally invasive manner. Our objective was to describe our center's outcomes and complications following epidural blood patches for symptomatic postoperative durotomies.
Patients undergoing spine surgeries at one institution from 2012-2020 were included. Patient charts were reviewed for demographic information, surgical data, rate of dural tear, type of repair, and use of blood patches postoperatively.
A total of 1392 patients (726 male, 666 female, average age: 56.3 ± 15.4 years), including 436 cervical and 956 posterior thoracolumbar/lumbar spine surgeries were screened. There were 6 (1.4%) cervical, 64 (6.7%) lumbar, and a total of 70 (5.0%) patients with incidental dural tears/blebs. Of these patients, we identified 2 cervical and 8 lumbar spine patients with persistent CSF leaks who received epidural blood patches postoperatively. Nine of 10 (90%) had resolution of symptoms. One lumbar patient failed both an initial blood patch and subsequent surgical re-exploration, but had successful relief after a second blood patch.
The incidence of dural tears/blebs was 1.4% in cervical, 6.7% in lumbar, and 5.0% in all spine surgeries. Of the 10 patients with symptomatic CSF leaks, 9 were successfully treated with blood patches. Targeted epidural blood patch is effective in treating symptomatic CSF leaks and minimizes the morbidity of surgical re-exploration.
导致术后出现症状性脑脊液（CSF）漏的意外硬脊膜切开术可通过卧床休息、蛛网膜下腔腰椎引流及手术再次探查进行治疗。另一种选择是硬膜外血贴，它以微创方式在硬脊膜撕裂处形成血凝块。我们的目的是描述在我们中心对有症状的术后硬脊膜切开术采用硬膜外血贴后的治疗效果及并发症情况。
纳入2012年至2020年在一家机构接受脊柱手术的患者。查阅患者病历以获取人口统计学信息、手术数据、硬脊膜撕裂发生率、修复类型及术后血贴使用情况。
共筛查了1392例患者（男性726例，女性666例，平均年龄：56.3±15.4岁），其中包括436例颈椎手术和956例胸腰段/腰椎后路脊柱手术。有6例（1.4%）颈椎手术、64例（6.7%）腰椎手术患者出现意外硬脊膜撕裂/小泡，总计70例（5.0%）。在这些患者中，我们确定有2例颈椎手术和8例腰椎手术患者术后持续存在脑脊液漏并接受了硬膜外血贴治疗。10例患者中有9例（90%）症状得到缓解。1例腰椎手术患者初次血贴及随后的手术再次探查均失败，但在第二次血贴后症状成功缓解。
硬脊膜撕裂/小泡的发生率在颈椎手术中为1.4%，在腰椎手术中为6.7%，在所有脊柱手术中为5.0%。在10例有症状性脑脊液漏的患者中，9例通过血贴成功治疗。针对性的硬膜外血贴在治疗有症状性脑脊液漏方面有效，并将手术再次探查的发病率降至最低。
