• 제목/요약/키워드: Epidural leakage

검색결과 35건 처리시간 0.024초

골다공증성 척추 압박골절 환자의 경피적 척추성형술에서 Polymethylmethacrylate의 경막 외 유출 (Epidural Leakage of Polymethylmethacrylate Following Percutaneous Vertebroplasty in the Patients with Osteoporotic Vertebral Compression Fractures)

  • 오윤규;류경식;박춘근;강준기
    • Journal of Korean Neurosurgical Society
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    • 제30권3호
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    • pp.319-324
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    • 2001
  • Objectives : The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. Methods : This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. Results : The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions : The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.

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Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

  • Kim, Sae-Young;Hong, Ji-Hee
    • The Korean Journal of Pain
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    • 제23권1호
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    • pp.46-50
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    • 2010
  • Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

경막외강 혈액첩포 시술로 두통이 호전된 후 반복적으로 발생한 두개내 저압증 1예 (A Case of Recurrent Intracranial Hypotension after Successful Epidural Blood Patch)

  • 이기라;최성민;이승한;박만석;김병채;김명규;조기현
    • Annals of Clinical Neurophysiology
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    • 제8권2호
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    • pp.190-192
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    • 2006
  • Intracranial hypotension is a benign disorder characterized by orthostatic headache. It is caused by CSF leakage, therefore its treatment of choice has been epidural blood patch when initial conservative treatments were not effective. We would like to report a 26-year-old patient with recurrent orthostatic intracranial hypotension in spite of the successful epidural blood patch several times. Her headache was caused by myelography 8 month ago. Cisternography showed a CSF leakage at the level of L1 vertebral body. Headache was resolved completely after epidural blood patch and then recurred 3 times several months after blood patch. Now, she is free from headache for 5 months after last blood patch.

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자발성 두개내 저압환자에서의 경막외 혈액봉합술 (Epidural Blood Patch to Treat Spontaneous Intracranial Hypotension)

  • 이청;송준걸;박재홍;신진우;최윤;윤창섭
    • The Korean Journal of Pain
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    • 제13권1호
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    • pp.79-83
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    • 2000
  • Background: Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The purpose of this study is to analyze the effect of epidural blood patch in spontaneous intracranial hypotension. Methods: The spontaneous intracranial hypotension patients treated with epidural blood patch were analyzed on the symptoms, radiologic images and methods of epidural blood patch retrospectively by the medical records. Results: Patients had postural headache (15 patients) including nausea/vomiting (10 patients), tinnitus (2 patients), neck stiffness (13 patients), vertigo (3 patients) and occular pain (1 patient). Brain CT and MRI showed diffuse enhancement of the pachymeninges (9 patients) and radionuclide cisternography demonstrated direct evidence of leakage (11 patients). With epidural blood patch, the symptoms were promptly relieved in 11 patients. Conclusions: We concluded that epidural blood patch is a good treatment of method in spontaneous intracranial hypotension patients.

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자기공명척수조영술을 이용한 수술 후 척추 뇌수막액 누출 평가 (Detection of Surgery-related Spinal Cerebrospinal Fluid Leakage Using Magnetic Resonance Myelography)

  • 구현정;김상준;정선주;임승철
    • Investigative Magnetic Resonance Imaging
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    • 제17권2호
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    • pp.149-153
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    • 2013
  • 척추 수술의 합병증으로 뇌척수액 누출이 발생할 수 있는데 이를 영상학적으로 진단하는 것은 어려움이 있다. 이 연구에서는 자기공명척수조영술을 이용하여 척추 수술 후 뇌척수액 누출을 확인하였던 두 환자의 증례를 보고하고자 한다. 두 환자는 각기 요추 추간판 절제술과 척추 수막종 제거술을 받은 뒤 심한 두통을 호소하였다. 두 환자의 자기공명척수조영영상에서 척추 뇌수막액 누출 부위가 확인되었고, 이에 대해 환자들은 각각 epidural blood patch와 재수술을 받았다. 이 두 사례에서 자기공명척수조영술은 척추 뇌수막액의 누출 부위를 정확히 보여주었고, 척수강과 가성수막류 (pseudomeningocele) 사이의 교통로를 잘 나타내주었다. 척수 수술 후 뇌수막액 누출을 확인하기 위한 검사로 자기공명척수조영술이 유용한 것으로 생각된다.

Pneumocephalus in a Patient with No Cerebrospinal Fluid Leakage after Lumbar Epidural Block - A Case Report -

  • Kim, Yeon-Dong;Lee, Jae-Hun;Cheong, Yong-Kwan
    • The Korean Journal of Pain
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    • 제25권4호
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    • pp.262-266
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    • 2012
  • Several complications are possible after a lumbar epidural block. However pneumocephalus are rare. In this case, we report a case of pneumocephalus. A 68-year-old male patient received lumbar epidural block with the loss of resistance technique using air, and after 35 minutes, apnea, unconsciousness, hypotension, and bradycardia occurred. Immediately, brain CT was done, and we found pneumocephalus. The patient complained of severe occipital headache and itchiness due to pneumocehalus. After conservative treatment, the patient recovered without neurologic complications, and on the seventh day of his hospitalization, he was discharged from the hospital.

요부 경막외 차단후 발생한 두통 및 기뇌증 -증례 보고- (Headache and Pneumocephalus after Lumbar Epidural Block -A case report-)

  • 한찬수;유진섭;김일호;김유재;김천숙;안기량
    • The Korean Journal of Pain
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    • 제9권1호
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    • pp.251-255
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    • 1996
  • Headache after epidural block is the most frequent result of an unintentional dural puncture. This form of headache is usually caused by cerebrospinal fluid leakage through the dural puncture site. Another proposed cause of postdural puncture headache is the unintentional injection of air into the subarachnoid space. We experienced a case of severe headache with a patient after lumbar epidural block and discovered air in the intracranial subarachnoid space(pneumocephalus) with the aid of brain computerized tomography.

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경추부 경막외 혈액 봉합술로 치료한 자발성 두개내 저압 -증례 보고- (A Case Report of Spontaneous Intracranial Hypotension Treated with Cervical Epidural Blood Patch -A case report-)

  • 정성원;도현우;이정구
    • The Korean Journal of Pain
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    • 제12권1호
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    • pp.157-161
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    • 1999
  • We report a patient with spontaneous intracranial hypotension. In addition to the cardinal feature of a postural headache and a low CSF pressure, the patient also had subdural hematoma demonstrated by brain MRI. Radionuclide cisternography revealed a CSF leakage in the intracranium. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Methods of treatment are identical to those for post-dural puncture headaches. We experienced a patient with spontaneous intracranial hypotension developed in the intracranium who was successfully managed with a cervical blood patch.

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Risk factors associated with repeated epidural blood patches using autologous blood

  • Oh, Ah Ran;Park, Jungchan;Jeong, Ji Seon;Lee, Jin Young;Choi, Ji Won;Kim, Hara;Sim, Woo Seog
    • The Korean Journal of Pain
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    • 제35권2호
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    • pp.224-230
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    • 2022
  • Background: An epidural blood patch (EBP) is a procedure to treat intracranial hypotension that does not respond to conservative treatment. EBPs are commonly repeated when the symptoms persist. In this study, we used a large single-center retrospective cohort and evaluated the factors associated with repeated EBPs. Methods: From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. We evaluated the factors associated with repeated EBPs in the entire population, in patients with spontaneous intracranial hypotension (SIH), and in those with available myelographies. Results: In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, international normalized ratio (INR) and cerebrospinal fluid (CSF) leakage on myelographies consistently exhibited significant associations (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.02-1.87; P = 0.043 and OR, 2.18; 95% CI, 1.28-3.69; P = 0.004). In patients with iatrogenic injury, INR and CSF leakage on myelogram did not show difference in repeated EBPs. Conclusions: Repeated EBPs may be more frequently required in patients with SIH. Prolonged INR and CSF leakage were associated with repeated EBPs in patient with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.

미추 경막외차단 도중 발견된 천추 수막낭 -증례 보고- (Sacral Meningeal Cyst Detected during Caudal Epidural Block)

  • 강미숙;임영진;이상철
    • The Korean Journal of Pain
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    • 제12권2호
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    • pp.258-262
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    • 1999
  • Sacral meningeal cyst is usually asymtomatic, but may be responsible for sciatic pain syndromes and other clinical symptoms. Sacral meningeal cyst might be suspected when definite explanation for the clinical symptom, such as herniation of the intervertebral disc or spinal stenosis is not found. Plain films and CT may suggest the presence of sacral meningeal cyst, but MR is the current imaging study of choice. Evaluation of the correlation between the symptom and the cyst is as important as detection of it. We have experienced a case of sacral meningeal cyst detected during caudal epidural block. The patient complained of low back pain radiating to thigh. Plain films and lumbar spine CT showed no remarkable finding except disc bulging. During caudal epidural needle insertion, there was leakage of clear CSF, and intrasacral cystic shadow was visualized by dye injection. MR confirmed sacral meningeal cyst.

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