Motov Stefan, Stienen Martin N
Department of Neurosurgery, Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland.
Department of Neurosurgery, Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland.
World Neurosurg. 2025 Jan;193:1058. doi: 10.1016/j.wneu.2024.11.108. Epub 2024 Dec 29.
Epidural anesthesia plays a key role in standard delivery procedures nowadays with a low periprocedural complications profile. Tearing of epidural catheters occurs rarely and may require a surgical extraction of the residual fragment. A 26-year-old obese female was referred after spontaneous delivery for an accidentally torn epidural catheter. Imaging revealed a 7 cm residual in the levels Th12-L2 suspected to be located epidurally. The unilateral biportal endoscopic (UBE) technique seemed ideal for exploring different compartments sequentially and for the removal of the material. After an uneventful extraction via the UBE approach, the patient was discharged home on the First postoperative day. We opted for a UBE removal in this case, as the torn catheter ending was located mediolaterally at the thoracolumbar junction and it was not completely evident to us, whether it would be located outside the ligamentum flavum or epidurally. Removal of a torn epidural catheter with the UBE technique is feasible and appears to be a safe and effective minimally invasive option to deal with these postnatal complications.
硬膜外麻醉在当今标准分娩程序中起着关键作用，围手术期并发症发生率较低。硬膜外导管撕裂很少发生，可能需要手术取出残留碎片。一名26岁肥胖女性在自然分娩后因硬膜外导管意外撕裂前来就诊。影像学检查显示，在胸12至腰2水平有一段7厘米的残留物，怀疑位于硬膜外。单侧双通道内镜（UBE）技术似乎非常适合依次探查不同腔隙并取出异物。通过UBE方法顺利取出异物后，患者在术后第一天出院。在本病例中我们选择UBE取出法，因为撕裂的导管末端位于胸腰段交界处的中外侧，我们并不完全清楚它是位于黄韧带外还是硬膜外。用UBE技术取出撕裂的硬膜外导管是可行的，似乎是处理这些产后并发症的一种安全有效的微创选择。
