METHODS: We report the case of a peripartum patient who developed a severe and persistent CSF leak unresponsive to multiple EBPs following a UDP during epidural catheter placement for labor analgesia. Lumbar MRI revealed a ventral rather than dorsal epidural fluid collection suggesting that the needle had crossed the thecal sac and punctured the ventral dura, creating a puncture site not readily accessible to blood injected in the dorsal epidural space. The location of this persistent ventral dural defect was confirmed with digital subtraction myelography, permitting a transdural surgical exploration and repair of the ventral dura with resolution of the severe intracranial hypotension.
CONCLUSIONS: A ventral rather than dorsal dural puncture is one mechanism that may contribute to both severe and persistent spinal CSF leak with resulting intracranial hypotension following a UDP.
方法:我们报告了一名围产期患者,该患者在硬膜外导管放置分娩镇痛期间发生严重和持续的CSF泄漏,对UDP后的多个EBPs无反应。腰椎MRI显示腹侧而非背侧硬膜外积液,提示针头穿过鞘囊并穿刺腹侧硬脑膜,在硬膜外背侧空间注射的血液不容易进入穿刺部位。通过数字减影脊髓造影证实了这种持续性腹侧硬脑膜缺损的位置,允许通过硬膜手术探查和修复腹侧硬脑膜,并解决严重的颅内低血压。
结论:腹侧而非背侧硬膜穿刺是一种机制,可能导致严重和持续的脊髓CSF漏,并导致UDP后的颅内低血压。