The Efficacy and Safety of Lumbar Accessed Catheter-Assisted Epidural Blood Patch in Cervical and Thoracic Cerebrospinal Fluid Leakage

Abstract

To evaluate the clinical and radiological results of lumbar accessed catheter-assisted epidural blood patch (LACA-EBP) technique in treatment of spontaneous intracranial hypotension secondary to cervicothoracic cerebrospinal fluid leakage. Patients presenting with spontaneous intracranial hypotension where magnetic resonance imaging cisternography confirmed and localized the cerebrospinal fluid leakage at cervicothoracic levels were treated with LACA-EBP. Visual analog scale (VAS) score for headache at baseline, third day after treatment, and during long-term follow-up was used to assess the treatment response. Posttreatment VAS score ≤3 on the third day defined treatment success, and VAS score ≥4 indicated treatment failure. LACA-EBP was performed in 10 patients (7 females, 3 males) with a mean age of 38.4 ± 10.5 years. Orthostatic headache was the most common presenting symptom (10/10; 100%) followed by nausea (5/10; 50%). Pituitary gland enlargement was the most commonly observed finding on pretreatment cranial magnetic resonance imaging (9/10; 90%). On magnetic resonance imaging cisternography, 8 patients had cervical and/or thoracic fistulas, whereas 2 patients had multiple-level fistulas. LACA-EBP was successful in all patients with no complications. All patients showed a treatment response with a 72-hour VAS score ≤3. Follow-up VAS scores were available for 8 patients with a clinical follow-up duration of 1-74 months (median 7.5 months). During clinical follow-up, headache recurred in 2 patients. In our study cohort, LACA-EBP was a safe and efficacious technique in treatment of cerebrospinal fluid leakage at cervical and thoracic levels.