Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

The Efficacy of a Fluoroscopy Guided Epidural Autologous Blood Patch In the Treatment of a Post-Dural Puncture Headache

경막천자 후 두통 환자에서 투시장치 유도하 경막외 혈액 봉합술의 효과 고찰

  • Park, Ji Eun (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Eugene (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Joon Woo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kang, Yusuhn (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Ahn, Joong Mo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kang, Heung Sik (Department of Radiology, Seoul National University Bundang Hospital)
  • 박지은 (분당서울대학교병원 영상의학과) ;
  • 이영준 (분당서울대학교병원 영상의학과) ;
  • 이준우 (분당서울대학교병원 영상의학과) ;
  • 강유선 (분당서울대학교병원 영상의학과) ;
  • 안중모 (분당서울대학교병원 영상의학과) ;
  • 강흥식 (분당서울대학교병원 영상의학과)
  • Received : 2017.11.21
  • Accepted : 2017.12.23
  • Published : 2018.04.01
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the efficacy of a fluoroscopy-guided epidural blood patch (EBP) in the treatment of a post-dural puncture headache (PDPH). Materials and Methods: From November 2013 to April 2017, a total of 164 patients (76 males, 88 females, mean age 40.7 years, age range 12 to 87 years) underwent a fluoroscopy guided EBP for the treatment of PDPH in the department of radiology. The treatment outcomes were classified as follows: complete relief, incomplete relief, failure, and recurrence. In the case of recurrence, the duration between the date of the first EBP and the date of recurrence was described. The effectiveness of the second EBP was also evaluated. Results: In 164 PDPH patients, complete relief was achieved in 157 patients (95.8%), incomplete relief was achieved in 1 patient (0.6%), failure in 2 patients (1.2%) and recurrence in 4 patients after the first EBP. All 4 recurrence patients and the 2 failure patients were discharged with complete relief after receiving one additional EBP. Conclusion: In patients with PDPH, a fluoroscopy-guided EBP is an effective treatment. Moreover, an additional EBP can be considered in the clinical failure or recurrence of PDPH after the first EBP.

목적: 경막천자 후 두통 환자에서 투시장치(fluoroscopy) 유도하 경막외 혈액 봉합술의 치료 효과를 평가하였다. 대상과 방법: 2013년 11월부터 2017년 4월까지 경막천자 후 발생한 두통 치료를 위해 본원 영상의학과에서 경막외 혈액봉합술을 시행 받은 164명의 의무기록을 후향적으로 분석하였다. 치료 효과는 완전 경감(complete relief), 불완전 경감(incomplete relief), 치료 실패(failure), 재발(recurrence)로 분류하였다. 재발한 경우 경막외 혈액 봉합술 시술일로부터 재발한 날 사이의 기간과 재시술 유무를 기술하고, 재시술 후 치료 효과를 기술하였다. 결과: 경막천자 후 체위성 두통을 호소하는 총 164명의 환자 중 첫 번째 경막외 혈액 봉합술 이후 157명(95.8%)에서 완전 경감을 보였다. 1명(0.6%)의 환자에서 불완전 경감, 2명(1.2%)의 환자에서는 치료 실패를 보였고 4명의 환자에서 재발했다. 4명의 재발 환자 및 2명의 치료 실패 환자 모두 추가적인 경막외 혈액 봉합술을 시행(1회)받은 후 모두 완전 경감 상태로 퇴원하였다. 결론: 경막천자 후 두통 환자에서 투시장치 유도하에 경막외 혈액 봉합술을 시행하여 체위성 두통의 치료를 효과적으로 할 수 있으며, 임상적으로 경막외 혈액 봉합술 시행 후에 발생한 두통의 치료 실패/재발의 경우 반복적인 경막외 혈액 봉합술을 고려해볼 수 있다.

Keywords

References

  1. Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med 2013;4:595-602
  2. Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care 1983;11:4-15
  3. Bezov D, Ashina S, Lipton R. Post-dural puncture headache: part II--prevention, management, and prognosis. Headache 2010;50:1482-1498 https://doi.org/10.1111/j.1526-4610.2010.01758.x
  4. Banks S, Paech M, Gurrin L. An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients. Int J Obstet Anesth 2001;10:172-176 https://doi.org/10.1054/ijoa.2000.0826
  5. Safa-Tisseront V, Thormann F, Malassine P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology 2001;95:334-339 https://doi.org/10.1097/00000542-200108000-00012
  6. Taivainen T, Pitkanen M, Tuominen M, Rosenberg PH. Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand 1993;37:702-705 https://doi.org/10.1111/j.1399-6576.1993.tb03793.x
  7. van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer- blind, controlled clinical trial. J Neurol Neurosurg Psychiatry 2008;79:553-558 https://doi.org/10.1136/jnnp.2007.122879
  8. Vercauteren MP, Hoffmann VH, Mertens E, Sermeus L, Adriaensen HA. Seven-year review of requests for epidural blood patches for headache after dural puncture: referral patterns and the effectiveness of blood patches. Eur J Anaesthesiol 1999;16:298-303 https://doi.org/10.1046/j.1365-2346.1999.00482.x
  9. Williams EJ, Beaulieu P, Fawcett WJ, Jenkins JG. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth 1999;8:105-109 https://doi.org/10.1016/S0959-289X(99)80007-7
  10. Watanabe K, Hashizume K, Kawaguchi M, Fujiwara A, Sasaoka N, Furuya H. Fluoroscopically guided epidural blood patch with subsequent spinal CT scans in the treatment of spontaneous cerebrospinal fluid hypovolemia. J Neurosurg 2011; 114:1731-1735 https://doi.org/10.3171/2011.1.JNS101326
  11. DiGiovanni AJ, Galbert MW, Wahle WM. Epidural injection of autologous blood for postlumbar-puncture headache. II. additional clinical experiences and laboratory investigation. Anesth Analg 1972;51:226-232
  12. Gormley JB. Treatment of post-spinal headache. Anesthesiology 1960;21:565-566
  13. Oedit R, van Kooten F, Bakker SL, Dippel DW. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomised, observer-blind, controlled clinical trial [ISRCTN 71598245]. BMC Neurol 2005;5:12 https://doi.org/10.1186/1471-2377-5-12
  14. Rice GG, Dabbs CH. The use of peridural and subarachnoid injections of saline solution in the treatment of severe postspinal headache. Anesthesiology 1950;11:17-23 https://doi.org/10.1097/00000542-195001000-00003
  15. Jeon JK, Choi KT. Epidural blood patch for post lumbar puncture headache. Korean J Anesthesiol 1988;21:863-871 https://doi.org/10.4097/kjae.1988.21.6.863
  16. Chen IW, Lin CM. Fluoroscopy-guided caudal epidural blood patch for relieving post-dural puncture headache after lumbar spine surgery. Egy J Anaesth 2017; 33:133-135 https://doi.org/10.1016/j.egja.2016.07.001
  17. Kawaguchi M, Hashizume K, Watanabe K, Inoue S, Furuya H. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth 2011;25:450-453 https://doi.org/10.1007/s00540-011-1135-2
  18. Bhandari A, Anand A, Khan F, Ellias M. Epidural blood patch: comparison of fluoroscopic guided technique versus nonfluoroscopic (blind) technique. The Pain Clinic 2001;13:77-82 https://doi.org/10.1163/15685690152385781
  19. Tekkok IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth 1996;43:306-309 https://doi.org/10.1007/BF03011749
  20. Sperry RJ, Gartrell A, Johnson JO. Epidural blood patch can cause acute neurologic deterioration. Anesthesiology 1995; 82:303-305 https://doi.org/10.1097/00000542-199501000-00038
  21. Yoon SH, Lee JW, Lee GY, Lee E, Kang HS. Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and postdural puncture headache. J Korean Soc Radiol 2014;70:299-305 https://doi.org/10.3348/jksr.2014.70.4.299
  22. Hayek SM, Fattouh M, Dews T, Kapural L, Malak O, Mekhail N. Successful treatment of spontaneous cerebrospinal fluid leak headache with fluoroscopically guided epidural blood patch: a report of four cases. Pain Med 2003;4:373-378 https://doi.org/10.1111/j.1526-4637.2003.03037.x
  23. Fry RA, Perera A. Failure of repeated blood patch in the treatment of spinal headache. Anaesthesia 1989;44:492-493 https://doi.org/10.1111/j.1365-2044.1989.tb11378.x
  24. Loeser EA, Hill GE, Bennett GM, Sederberg JH. Time vs. success rate for epidural blood patch. Anesthesiology 1978;49: 147-148 https://doi.org/10.1097/00000542-197808000-00024
  25. Ho KY, Gan TJ. Management of persistent post-dural puncture headache after repeated epidural blood patch. Acta Anaesthesiol Scand 2007;51:633-636 https://doi.org/10.1111/j.1399-6576.2007.01283.x