• Title/Summary/Keyword: Epidural leakage

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Treatment with Epidural Blood Patch for Iatrogenic Intracranial Hypotension after Spine Surgery

  • Kim, Jaekook;Lee, Sunyeul;Ko, Youngkwon;Lee, Wonhyung
    • Journal of Korean Neurosurgical Society
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    • v.52 no.3
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    • pp.254-256
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    • 2012
  • Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage, Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.

Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

  • Kim, Myungsoo;Park, Ki-Su
    • Journal of Korean Neurosurgical Society
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    • v.58 no.2
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    • pp.144-146
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    • 2015
  • Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

Video-assisted Thoracioscopic Surgery under Epidural Anesthesia in the High-Risk Patients with Secondary Spontaneous Pneumothorax (고위험인자를 가진 이차성 자연 기흉환자의 경막외마취를 이용한 흉강경 수술)

  • 김영대;박준호;양승인
    • Journal of Chest Surgery
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    • v.36 no.9
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    • pp.678-682
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    • 2003
  • Video-assisted thoracoscopic surgery is good indication of secondary spontaneous pneumothorax. This method usually required general anesthesia and single-lung ventilation with collapse of other lung. But, risks of general anesthesia and single-lung ventilation must be considered in high-risk patients. Material and Method: Between September f999 and August 2001, 15 high-risk patients were treated by video-assisted thoracoscopic surgery under epidural anesthesia. Result: Video assisted thoracoscopic surgery was successfully performed in 15 patients. Duration of postoperative air-leakage was 4.3days, Significance of complication was none, No recurrence of pneumothorax was encountered. Conclusion: Video-assisted thoracoscopic surgery can be performed safely under epidural anesthesia for treatment of secondary spontaneous pneumothorax in high-risk patients.

Acute Subdural Hematoma after Accidental Dural Puncture During Epidural Anesthesia

  • Kim, Il-Sup;Lee, Sang-Won;Son, Byung-Chul;Hong, Jae-Taek
    • Journal of Korean Neurosurgical Society
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    • v.40 no.5
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    • pp.384-386
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    • 2006
  • Acute subdural hematoma is an exceptionally rare, but life-threatening complication of spinal anesthesia. The authors report here on a case of acute subdural hematoma in a 52-year-old male who underwent an arthroscopic knee joint operation under spinal epidural anesthesia due to tearing of the medial meniscus. He complained of headache after surgery. Computed tomography[CT] revealed acute subdural hematoma in the right fronto-tempo-parietal area. The headache progressed in spite of analgesics and bed rest; two weeks later, the CT showed subacute subdural hematoma with a mass effect. The patient improved after surgical decompression. The pathogenesis of subdural hematoma formation after dural puncture is discussed and we briefly review the relevant literature. Prolonged and severe postdural puncture headache[PDPH] should be viewed with suspicion and investigated promptly to rule out any intracranial complications. Immediate treatment of the PDPH with an epidural blood patch to prevent further CSF leakage should be considered.

Bibrachial Amyotrophy Associated with Epidural Cerebrospinal Fluid Leakage: A Case Report (경막외 뇌척수액 누출과 연관된 양측 상지 근위축증: 증례보고)

  • Rho, Hyunwoo;Jeong, Jiseon;Sung, Duk Hyun
    • Journal of Electrodiagnosis and Neuromuscular Diseases
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    • v.20 no.2
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    • pp.112-118
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    • 2018
  • We describe a case of a 71-year-old male patient who experienced progressive bilateral proximal upper limb weakness and atrophy without sensory symptoms and signs over 5 years. Electromyography demonstrated denervation potentials and neuropathic motor unit action potentials on C5-C7 myotome muscles bilaterally. Cervical spine magnetic resonance imaging revealed engorged anterior epidural venous plexus, T2 hyperintensity localized to grey matter ("snake-eye" appearance) at C2-C6 vertebral level, and ventral epidural fluid collection from C6 to T8 vertebral level. This case indicates that bibrachial amyotrophy associated with epidural fluid leak should be suspected in patients presenting with progressive bilateral upper limb weakness and atrophy without sensory involvement.

Cerebrospinal Fluid Pressure Changes Following the Injection of Saline into the Epidural Space (경막외강(硬膜外腔)에 주입(注入)한 생리식염수(生理食鹽水)가 뇌척수액압(腦脊髓液壓)에 미치는 영향(影響))

  • Jeon, Jae-Kyu;Lee, Suck-Kang;Choo, Young-Eun
    • The Korean Journal of Physiology
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    • v.11 no.1
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    • pp.21-26
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    • 1977
  • Many cases have been reported that a post spinal headache can be relieved immediately by an epidural injection of saline; and autologous blood also has recently been used successfully instead of saline. The changes of the cerebrospinal fluid pressure in 40 cases were observed in the present study in support of the concept; that a continuous leakage in association with hypovolemia and hypotension of the cerebrospinal fluid is the primary cause of a post spinal headache. Subarachnoid pressure increased immediately with saline injection into the lumber epidural space. A spinal needle was inserted into the subarachnoid space at the level of $L2{\sim}3$ and opening pressure of the cerebrospinal fluid was read. An epidural Tuohy needle was insertad at the$L3{\sim}4$ and 25m1 of saline was injected into the epidural space and the cerebrospinal fluid pressure was read in the sitting position. $\underline{Sitting\;Position:}$ Mean pressure after injection $555{\pm}(110.9)mm\;H_2O$, Pressure rise rise (%) 51.3%, Mean opening pressure $366{\pm}(52.2)mm\;H_{2}O$, $\underline{Lateral\;position:}$ Mean pressure after injection $308{\pm}(70.8)mm\;H_{2}O$, Pressure(%) 86.7%, Mean opening pressure $165{\pm}(42.6)mm\;H_{2}O$. These pressure changes responded almost simultaneously as saline was injected. This pressure rise of 51.3% in the sitting position and 86.7% in the lateral position are clinically very significant. Therefore, it is most possible that the immediate relieve of post, spinal headache by injection of fluid into the epidural space is simultaneous with the increase of the cerebrospinal fluid pressure.

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Role of Muscle Free Flap in the Salvage of Complicated Scalp Wounds and Infected Prosthetic Dura

  • Han, Dae Hee;Park, Myong Chul;Park, Dong Ha;Song, Hyunsuk;Lee, Il Jae
    • Archives of Plastic Surgery
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    • v.40 no.6
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    • pp.735-741
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    • 2013
  • Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura.

Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma

  • An, Sungjae;Jeong, Han-Gil;Seo, Dongwook;Jo, Hyunjun;Lee, Si Un;Bang, Jae Seung;Oh, Chang Wan;Kim, Tackeun
    • Journal of Korean Neurosurgical Society
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    • v.65 no.1
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    • pp.13-21
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    • 2022
  • Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.

Efficacy of Middle Meningeal Artery Embolization in Treatment Resistant Spontaneous Intracranial Hypotension Caused Subdural Hematoma : Report of Two Cases and Review of the Literature

  • Evran, Sevket;Kayhan, Ahmet;Saygi, Tahsin;Ozbek, Muhammet Arif;Kilickesmez, Ozgur
    • Journal of Korean Neurosurgical Society
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    • v.65 no.6
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    • pp.868-874
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    • 2022
  • Spontaneous intracranial hypotension (SIH) most commonly manifests as bilateral subdural hematoma (SH). SIH cases mostly resolve spontaneously but further treatment would be needed via blind epidural blood patch (EBP). Cerebrospinal fluid (CSF) leakage in EBP-refractory cases can be treated surgically only if the localization of CSF leakage is detectable but it cannot be possible in most of the cases. Also surgical evacuation of SH secondary to SIH (SH-SIH) is not favorable without blocking the CSF leakage. Thus the management of these patients is a challenge and alternative treatment options are needed. Although middle meningeal artery embolization (MMAE) is an effective treatment option in non-SIH SH, there is no report about its application in the treatment of SH-SIH. We present two cases of SH-SIH which their clinical and radiological findings were completely resolved by bilateral MMAE treatment.

Pain Management of Terminal Cancer Patients by Intrathecal Injection of Local Anesthetics, Opioid and Adjuvants -A report of two cases- (지주막하강내 약물투여에 의한 말기암 환자의 통증관리 -증례 보고-)

  • Lee, Seon-Hwa;Kim, Jong-Il;Lee, Sang-Gon;Ban, Jong-Seuk;Min, Byoung-Woo
    • The Korean Journal of Pain
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    • v.13 no.2
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    • pp.259-262
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    • 2000
  • There are many difficulties in the management of terminal cancer pain. We often encounter difficulties when nerve blocks or epidural injection of drugs do not produce good results. Local anesthetics, opioids and adjunctives, were administered to two patients intrathecally. The results were very satisfactory. It has complications such as hypotension or infection due to intrathecal route. In the first case, the pancreatic cancer patient complicated with severe epigastic pain but unfortunately no management was effective in pain control. Intrathecal injection of bupivacaine and morphine mixture was successful even if syncope which was relieved by bed rest. In the second case, the patient complicated with lower abdominal pain due to ovarian cancer who very well controlled by epidural injection of morphine and clonidine mixture but morphine demand was greatly increased. Intrathecal injection of morphine and ketamine were tried. The patient had comportable analgesic effect. CSF leakage to subcutaneous occurred but resolved by change of the catheter position or retunnelling. There were no significant complications reported in two cases.

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