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Title: CT Guided Targeted Epidural Blood Patch: A Case Series
e-poster Number: EPOS 27
Category: e Poster
Author Name: Dr. Gurtejsingh Sardar
Institute:
Co-Author Name:
Abstract :
Intracranial hypotension (IIH), presents with clinical symptoms of postural headache, nausea, vomiting, visual and hearing disturbances, etc. One of the common causes are a CSF leak along the neuraxis, with prevalence of 5 per 100,000/year. IIH is either of primary (aka spontaneous intracranial hypotension or SIH) or secondary origin (iatrogenic / traumatic). One of the common causes for SIH is leakage of CSF from the thecal sac due to dural tears caused by calcified IVD spurs or osteophytes.
Management involves conservative management for acute and uncomplicated headaches with mild to moderate severity. For refractory headache, the first-line therapy would be an epidural blood patch (EBP).
The traditional blind method of epidural blood patch, involves a large quantity of autologous blood injected at the site of the lumbar puncture, and temporary relief is achieved. This however is suboptimal, as most dural tears occur at the thoracic spine.
In our study, patients diagnosed with SIH on imaging with evidence of osteophyte induced dural tears, underwent targeted epidural blood patch under CT guidance.
CT guided EBP was done in the prone position under LA. Over a period of 12 months, 7 patients were selected in whom SIH was due to dural rent due to osteophytes which was confirmed on CT myelography. All patients tolerated the procedure (as described above) well, and no intra-procedural complications. All patients had symptomatic relief within a few hours after the procedure, and none had recurrence on follow up (3 months).
EBP is a safe and effective method for the management of headaches due to SIH, refractory to medical management. The risks are essentially the same as with other epidural procedures and with proper technique, infectious complications are extremely rare.
Performing EBP under CT guidance allows targeted therapy, at higher vertebral body levels, and provides long term relief.
