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Eric W. Nottmeier - One of the best experts on this subject based on the ideXlab platform.

  • Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided Epidural Blood Patch.
    Journal of Neurosurgical Anesthesiology, 2012
    Co-Authors: Steven R. Clendenen, Stephen M. Pirris, Christopher B. Robards, Bruce Leone, Eric W. Nottmeier
    Abstract:

    BACKGROUND: A persistent cerebrospinal fluid leak after spinal surgery can be associated with both meningitis and/or pneumocephalus. Therefore, early active intervention is recommended with surgical exploration, lumbar subarachnoid drain, and less commonly Epidural Blood Patch. In the absence of a ligamentum flavum, the use of high-resolution ultrasound (US) spine imaging enables real-time advancement of a Tuohy needle towards the dura and the precise injection of Blood to cover the dural defect. METHODS: Six patients, after lumbar spine surgery with instrumentation and primary closure was complicated by incidental dural tears, developed severe symptomatic headaches that failed conservative therapy. All patients underwent US-guided Epidural Blood Patch. Precise needle advancement to the dura was observed with US guidance, and 4-dimensional US scanning was used to confirm the expansion of Blood over the dura in real time. RESULTS: All patients had symptomatic relief of their headaches and successful treatment of dural leaks using US-guided Blood Patch. CONCLUSIONS: Real-time US guidance allowed accurate positioning of the Tuohy needle and deposition of the Epidural Blood Patch in the setting of a surgically removed ligamentum flavum. Further investigations are needed to confirm that an US-guided Epidural Blood Patch may offer reliable symptomatic relief to postsurgical persistent cerebrospinal fluid leak and may serve as an intermediate step along a spectrum between conservative initial management and surgical reexploration.

  • symptomatic postlaminectomy cerebrospinal fluid leak treated with 4 dimensional ultrasound guided Epidural Blood Patch
    Journal of Neurosurgical Anesthesiology, 2012
    Co-Authors: Steven R. Clendenen, Stephen M. Pirris, Christopher B. Robards, Bruce Leone, Eric W. Nottmeier
    Abstract:

    Background:A persistent cerebrospinal fluid leak after spinal surgery can be associated with both meningitis and/or pneumocephalus. Therefore, early active intervention is recommended with surgical exploration, lumbar subarachnoid drain, and less commonly Epidural Blood Patch. In the absence of a li

Charles H Mcleskey - One of the best experts on this subject based on the ideXlab platform.

Ray A Brinker - One of the best experts on this subject based on the ideXlab platform.

  • spinal subdural haematoma as a complication of immediate Epidural Blood Patch
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1996
    Co-Authors: Ismail H Tekkok, David A Carter, Ray A Brinker
    Abstract:

    The authors report a case of a patient who developed spinal subdural haematoma after a series of Epidural Blood Patches to alert anaesthetists to this rare complication. The patient was a 35-yr-old woman without coagulopathy and was initially treated elsewhere for chronic pain by repetitive Epidural phenol injections. When the dura was inadvertently punctured during subsequent attempts to inject phenol, immediate Epidural Blood Patch was performed to treat or prevent headache. The patient developed cauda equina syndrome after six Epidural Blood Patches. The clinical diagnosis was confirmed by magnetic resonance imaging and the intradural haematoma was evacuated surgically. The patient made a complete recovery. Epidural Blood Patch is not without complications. Transient backache and/or radiculopathy may occur in up to one-third of patients receiving a Blood Patch. If signs and symptoms continue or worsen, a spinal subarachnoid and/or subdural haematoma should be suspected and neurosurgical opinion sought. The technique used to identify the Epidural space is important in preventing subdural injection of Blood. The needle should be withdrawn after durai puncture and the Epidural space identified at a different level. Blood Patches may carry a higher risk of serious complications after multiple Epidural phenol injections because of fibrosis and obliteration of the Epidural space. Magnetic resonance scans reliably demonstrate the extent of the pathology. If diagnosed and treated before irreversible changes occur, spinal intradural haematoma can result in complete recovery.

Shuujiun Wang - One of the best experts on this subject based on the ideXlab platform.

  • factors predicting response to the first Epidural Blood Patch in spontaneous intracranial hypotension
    Brain, 2017
    Co-Authors: Jrwei Wu, Shushya Hseu, Jiingfeng Lirng, Yenfeng Wang, Weita Chen, Shihpin Chen, Shuujiun Wang
    Abstract:

    Spontaneous intracranial hypotension results from cerebrospinal fluid leakage. Currently, the treatment of choice for spontaneous intracranial hypotension is the Epidural Blood Patch, which has a variable response rate and no clear outcome predictors. This study aimed to identify predictors for response rate of a first targeted Epidural Blood Patch in patients with spontaneous intracranial hypotension. We reviewed cases of patients with spontaneous intracranial hypotension who received targeted Epidural Blood Patch at our hospital between 1 January 2007 and 1 July 2014. The outcome measure was first Epidural Blood Patch response. We analysed demographics, clinical manifestations, neuroimaging findings (non-contrast heavily T2-weighted magnetic resonance myelography and brain magnetic resonance imaging), and Blood volume as potential outcome predictors. Significant predictors were tested and a decision tree was used to construct a predictive model. In total, 150 patients with spontaneous intracranial hypotension were included for final analyses. Their overall first targeted Epidural Blood Patch response rate was 58.7%. Among patients with a greater injected Blood volume (≥22.5 versus <22.5 ml), the response rate was higher (67.9% versus 47.0%, P = 0.01). In brain and spinal magnetic resonance imaging studies, significant predictors included anterior Epidural cerebrospinal fluid collection length (<8 versus ≥8 segments; 72.5% versus 37.3%, odds ratio = 4.4, 95% confidence interval: 2.2–8.9, P < 0.001) and midbrain-pons angle (≥40° versus <40°; 71.3% versus 37.5%, odds ratio = 4.1, 95% confidence interval 2.1–8.3, P < 0.001). Decision tree analyses showed that patients with anterior Epidural CSF collection involving <8 segments and an injected Blood volume ≥22.5 ml had an 80.0% response rate. Patients with anterior Epidural cerebrospinal fluid collection involving ≥8 segments and a midbrain-pons angle <40° had a 21.2% response rate. These three variables predicted first Epidural Blood Patch response in 71.3% of patients. Brain and spinal neuroimaging findings and Epidural Blood Patch Blood volume can be used to predict targeted first Epidural Blood Patch response in patients with spontaneous intracranial hypotension. * Abbreviations : EBP : Epidural Blood Patch MRM : magnetic resonance myelography SIH : spontaneous intracranial hypotension

  • Factors predicting response to the first Epidural Blood Patch in spontaneous intracranial hypotension
    Brain, 2017
    Co-Authors: Jrwei Wu, Shushya Hseu, Jiingfeng Lirng, Yenfeng Wang, Weita Chen, Shihpin Chen, Shuujiun Wang
    Abstract:

    Spontaneous intracranial hypotension results from cerebrospinal fluid leakage. Currently, the treatment of choice for spontaneous intracranial hypotension is the Epidural Blood Patch, which has a variable response rate and no clear outcome predictors. This study aimed to identify predictors for response rate of a first targeted Epidural Blood Patch in patients with spontaneous intracranial hypotension. We reviewed cases of patients with spontaneous intracranial hypotension who received targeted Epidural Blood Patch at our hospital between 1 January 2007 and 1 July 2014. The outcome measure was first Epidural Blood Patch response. We analysed demographics, clinical manifestations, neuroimaging findings (non-contrast heavily T2-weighted magnetic resonance myelography and brain magnetic resonance imaging), and Blood volume as potential outcome predictors. Significant predictors were tested and a decision tree was used to construct a predictive model. In total, 150 patients with spontaneous intracranial hypotension were included for final analyses. Their overall first targeted Epidural Blood Patch response rate was 58.7%. Among patients with a greater injected Blood volume (≥22.5 versus

G Osullivan - One of the best experts on this subject based on the ideXlab platform.

  • subdural haematoma after dural puncture headache treated by Epidural Blood Patch
    BJA: British Journal of Anaesthesia, 2001
    Co-Authors: J M Davies, A Murphy, M Smith, G Osullivan
    Abstract:

    Subdural haematoma is a well-documented complication of accidental dural puncture, and is thought to be preventable by prompt treatment with an Epidural Blood Patch. An accidental dural puncture occurred in a 39-yr-old primagravida during the siting of an Epidural catheter for pain relief in labour. Twenty hours after the puncture, the mother developed a typical post-dural puncture headache, which increased in severity over the subsequent 24 h. An Epidural Blood Patch was performed at 48 h, and this initially relieved the headache. After discharge from hospital, and 14 days after the dural puncture, the headache recurred, together with expressive dysphasia, poor co-ordination and sensory loss in the right arm. A magnetic resonance imaging scan demonstrated a left sided subdural haematoma, which was drained successfully with complete recovery.