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用于多处脑脊液漏的单节段硬膜外血补丁：其作用机制

A Single-Level Epidural Blood Patch for Multiple Cerebrospinal Fluid Leaks: How it Works.

作者信息

Swain Amlan, Sahu Seelora, Kumari Rashmi, Tripathi Manjul

机构信息

Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, Jharkhand, India.

Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

Anesth Essays Res. 2022 Jul-Sep;16(3):416-418. doi: 10.4103/aer.aer_131_22. Epub 2022 Dec 9.

DOI:10.4103/aer.aer_131_22
PMID:36620106
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9813988/
Abstract

Spontaneous intracranial hypotension caused by cerebrospinal fluid (CSF) leak is a rarely encountered cause of persistent postural headaches in the absence of trauma or dural puncture. It presents with postural headache and is characterized by radiological findings of spinal CSF leak. The mainstay of management is an epidural patch with the patient's own blood (epidural blood patch [EBP]) and/or a fibrin glue product. We report here a case of spontaneous intracranial hemorrhage presenting with persistent headaches and bilateral subdural hematomas secondary to CSF leaks at multiple levels along the spinal cord, which was successfully managed with a single lumbar EBP.

摘要

脑脊液（CSF）漏所致的自发性颅内低压是在无创伤或硬膜穿刺情况下持续性体位性头痛的罕见原因。其表现为体位性头痛，并以脊髓脑脊液漏的影像学表现为特征。主要治疗方法是使用患者自身血液进行硬膜外填充（硬膜外血贴 [EBP]）和/或纤维蛋白胶产品。我们在此报告一例自发性颅内出血病例，该病例表现为持续性头痛和双侧硬膜下血肿，继发于脊髓多个节段的脑脊液漏，通过单次腰椎EBP成功治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45da/9813988/5e774844be06/AER-16-416-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45da/9813988/d4a83fb017d7/AER-16-416-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45da/9813988/5e774844be06/AER-16-416-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45da/9813988/d4a83fb017d7/AER-16-416-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45da/9813988/5e774844be06/AER-16-416-g002.jpg

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本文引用的文献

1
Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management.自发性颅内低压：综述及管理算法介绍
World Neurosurg. 2017 May;101:343-349. doi: 10.1016/j.wneu.2017.01.123. Epub 2017 Feb 9.
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Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension.预测自发性颅内低血压患者对首次硬膜外血贴治疗反应的因素。
Brain. 2017 Feb;140(2):344-352. doi: 10.1093/brain/aww328. Epub 2017 Jan 2.
3
Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension.
用于检测自发性颅内低压中脊髓脑脊液漏的脊髓造影技术
AJR Am J Roentgenol. 2016 Jan;206(1):8-19. doi: 10.2214/AJR.15.14884.
4
Targeted epidural patch with n-butyl cyanoacrylate (n-BCA) through a single catheter access site for treatment of a cerebral spinal fluid leak causing spontaneous intracranial hypotension.通过单一导管接入部位使用氰基丙烯酸正丁酯（n-BCA）进行靶向硬膜外贴片治疗导致自发性颅内低压的脑脊液漏。
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Lumbar blood patching for proximal CSF leaks: where does the blood go?用于近端脑脊液漏的腰椎血液填充：血液流向何处？
BMJ Case Rep. 2015 Feb 26;2015:bcr2014206933. doi: 10.1136/bcr-2014-206933.
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Spontaneous CSF leaks: low CSF volume syndromes.自发性脑脊液漏：低脑脊液容量综合征。
Neurol Clin. 2014 May;32(2):397-422. doi: 10.1016/j.ncl.2013.11.002. Epub 2014 Feb 28.
7
Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension.在屈氏体位下预先使用乙酰唑胺进行硬膜外血贴治疗自发性颅内低血压。
Eur J Neurol. 2010 May;17(5):715-9. doi: 10.1111/j.1468-1331.2009.02913.x. Epub 2009 Dec 29.
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Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.自发性脊柱脑脊液漏和颅内低压
JAMA. 2006 May 17;295(19):2286-96. doi: 10.1001/jama.295.19.2286.
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Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks.自发性脊柱脑脊液漏硬脑膜缺损的手术解剖学
Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-238-45; discussion ONS-245. doi: 10.1227/01.NEU.0000204712.16099.FB.
10
The efficacy of epidural blood patch in spontaneous CSF leaks.硬膜外血贴治疗自发性脑脊液漏的疗效
Neurology. 2001 Nov 27;57(10):1921-3. doi: 10.1212/wnl.57.10.1921.