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Lack of Increase in Intracranial Pressure After Epidural Blood Patch in Spinal Cerebrospinal Fluid Leak

Fichtner, Jens ; Fung, Christian ; Z'sGraggen, Werner ; Raabe, Andreas ; Beck, Jürgen

In: Neurocritical Care, 2012, vol. 16, no. 3, p. 444-449

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    Title
    • Lack of Increase in Intracranial Pressure After Epidural Blood Patch in Spinal Cerebrospinal Fluid Leak
    Author
    • Fichtner, Jens. Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland
    • Fung, Christian. Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland
    • Z'sGraggen, Werner. Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland
    • Raabe, Andreas. Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland
    • Beck, Jürgen. Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:311956
    Summary
    Background and Importance: Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP. Clinical Presentation: This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits. Conclusion: A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal epidural blood patching