Edanaga Mitsutaka, Morohara Sayaka, Hamada Kosuke, Komatsu Katsuya, Yamakage Michiaki
Anesthesiology, Sapporo Medical University, Sapporo, JPN.
Anesthesiology, Sapporo Kiyota Hospital, Sapporo, JPN.
Cureus. 2025 Feb 5;17(2):e78578. doi: 10.7759/cureus.78578. eCollection 2025 Feb.
This report describes the use of three fluoroscopy-guided epidural blood patch procedures to treat a patient with spontaneous intracranial hypotension. A 42-year-old woman with no history of history of surgery or trauma presented with headache and dizziness. Magnetic resonance imaging revealed an extradural cerebrospinal fluid leak collection leading to a diagnosis of spontaneous intracranial hypotension. Common symptoms of spontaneous intracranial hypotension include orthostatic headache, nausea, neck pain, hearing disturbance, dizziness, and aural fullness. However, the cause of spontaneous intracranial hypotension in this patient was not clear. Conservative therapy as the first treatment for spontaneous intracranial hypotension failed to alleviate the patient's symptoms. Subsequently, the anesthetist performed fluoroscopy-guided preoperative epidural catheterization in the prone position thrice. After the symptomatic improvement, the patient was discharged on the 118 day after admission. Although the treatment with an epidural blood patch became the standard of care in Japan from 2016, the fluoroscopy-guided method has not been generalized yet. Our report suggests that the fluoroscopy-guided approach for the epidural blood patch in the prone position is safe and reliable.
本报告描述了使用三种荧光透视引导下的硬膜外血贴疗法治疗一名自发性颅内低压患者的情况。一名无手术或外伤史的42岁女性出现头痛和头晕症状。磁共振成像显示硬膜外脑脊液漏聚积，导致诊断为自发性颅内低压。自发性颅内低压的常见症状包括体位性头痛、恶心、颈部疼痛、听力障碍、头晕和耳部胀满感。然而，该患者自发性颅内低压的病因尚不清楚。作为自发性颅内低压的首选治疗方法，保守治疗未能缓解患者症状。随后，麻醉师在俯卧位进行了三次荧光透视引导下的术前硬膜外导管插入术。症状改善后，患者在入院后第118天出院。尽管自2016年起硬膜外血贴疗法在日本已成为标准治疗方法，但荧光透视引导法尚未得到广泛应用。我们的报告表明，俯卧位荧光透视引导下的硬膜外血贴方法安全可靠。
