Associate Professor, Division of Interventional Radiology, Department of Radiology, Grant Government Medical College and Sir J J Group of Hospitals, Mumbai, Maharashtra, India, Corresponding Author.
Consultant, HOD, Department of Radiology, Saifee Hospital, Mumbai, Maharashtra, India.
J Assoc Physicians India. 2024 Aug;72(8):48-51. doi: 10.59556/japi.72.0608.
Lumbar epidural blood patch (EBP) is not successful in all cases of cerebrospinal fluid (CSF) leak, particularly in the cervicothoracic region. The present study is a retrospective analysis of a cohort of patients who had undergone computed tomography (CT)-guided cervical EBP for spontaneous intracranial hypotension (SIH) due to CSF leak in the cervical region.
We retrospectively collected data from March 2009 to 2020. Our inclusion criteria were (1) clinical syndrome associated with CSF leak, (2) headache coming on shortly after assuming the erect position and relief achieved by lying down, (3) CT myelography evidence of CSF leak in the cervical region, and (4) patient not responding to conservative management for 7 days. Exclusion criteria were patients with bleeding diathesis and infection. There were six females and four males. Ages ranged from 32 to 57, with an average of 42 years. On presentation, all patients underwent contrast-enhanced magnetic resonance imaging (MRI) and CT myelography. Cervical EBP was done under CT scan guidance. Assessment of headache was done on a 10-point numerical rating scale (NRS) before and after the procedure. Results are categorized into complete relief, partial relief, and no relief categories.
Nine out of 10 patients were completely recovered. One patient was partially recovered. The average NRS scale was 9.6 before treatment, which became 0.4 after EBP. No neurological or vascular complications were seen.
Computed tomography-guided cervical EBP is an optimum and effective way of treating SIH due to a leak in the cervical region. It has a higher success rate than lumbar EBP. However, prospective randomized controlled trials of cervical vs lumbar EBP will further validate our observation.
腰椎硬膜外血贴（EBP）并非对所有脑脊液（CSF）漏的情况都有效，尤其是在颈胸区域。本研究回顾性分析了一组因颈区 CSF 漏而发生自发性颅内低血压（SIH）的患者，他们接受了 CT 引导下的颈椎 EBP。
我们回顾性地收集了 2009 年 3 月至 2020 年的数据。纳入标准为：（1）与 CSF 漏相关的临床综合征；（2）头痛在直立后很快出现，躺下后缓解；（3）CT 脊髓造影显示颈区 CSF 漏；（4）7 天内保守治疗无效。排除标准为出血倾向和感染患者。共有 6 名女性和 4 名男性，年龄 32 至 57 岁，平均 42 岁。所有患者均行增强磁共振成像（MRI）和 CT 脊髓造影检查，然后在 CT 扫描引导下行颈椎 EBP。在治疗前后采用 10 分制数字评分量表（NRS）评估头痛。结果分为完全缓解、部分缓解和无缓解。
10 例患者中有 9 例完全缓解，1 例部分缓解。治疗前 NRS 平均为 9.6，治疗后为 0.4。未出现神经或血管并发症。
CT 引导下颈椎 EBP 是治疗颈区 CSF 漏所致 SIH 的有效方法，成功率高于腰椎 EBP。但颈椎与腰椎 EBP 的前瞻性随机对照试验将进一步验证我们的观察结果。
