背景:腰椎硬膜外补血片(EBP)在所有脑脊液(CSF)漏的情况下都不是成功的,特别是在颈胸区域。本研究是对一组接受计算机断层扫描(CT)引导的宫颈EBP治疗因宫颈区域CSF渗漏引起的自发性颅内低血压(SIH)的患者的回顾性分析。
方法:我们回顾性收集了2009年3月至2020年的数据。我们的纳入标准是(1)与脑脊液漏相关的临床综合征,(2)在采取直立姿势和躺下获得缓解后不久出现头痛,(3)颈部脑脊液漏的CT脊髓造影证据,(4)患者对保守治疗7天没有反应。排除标准为出血素质和感染患者。有六名女性和四名男性。年龄从32岁到57岁不等,平均42岁。在介绍时,所有患者均接受对比增强磁共振成像(MRI)和CT脊髓造影.宫颈EBP在CT扫描引导下进行。在手术前后以10点数字评定量表(NRS)进行头痛评估。结果分为完全缓解,部分缓解,没有救济类别。
结果:10例患者中有9例完全康复。一名患者部分康复。治疗前平均NRS量表为9.6,在EBP之后变为0.4。未见神经或血管并发症。
结论:计算机断层扫描引导的宫颈EBP是治疗因宫颈区域渗漏引起的SIH的最佳有效方法。它比腰椎EBP具有更高的成功率。然而,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.
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.