gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Operative results in the treatment of intracranial hypoptension: Case series of 7 patients

Meeting Abstract

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  • P. Klassen - Neurochirurgische Klinik, Klinikum Duisburg
  • E. Al-Khalout - Neurochirurgische Klinik, Klinikum Duisburg
  • W. Hassler - Neurochirurgische Klinik, Klinikum Duisburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.08-01

DOI: 10.3205/09dgnc221, URN: urn:nbn:de:0183-09dgnc2216

Published: May 20, 2009

© 2009 Klassen et al.
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Outline

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Objective: Safety and effectiveness of the administration of an extensive blood patch in the awake patient by two surgically placed epidural catheters: case series of 7 patients.

Methods: We analyzed 7 consecutive patients in our department treated with this method in the time from 2005 to 2008. All patients where referred with typical symptoms of orthostatic headache, combined with neck pain or not, nausea, blurred vision and distorted hearing. One patient had a history of minor axial trauma.

MRI imaging demonstrated typicall dural gadolinium enhancement, showing subdural effusions in three patients, a spinal effusion in one patient.

Routinely performed myelography and post-myelo-CT revealed dural tears in two patients. Therapy consisted in thoracolumbar monosegmental hemilaminectomy and epidural silicone catheter placement under general anaesthesia. In the awake patient, an extensive blood patch of a minimum of 25 ml each was administered with subsequent removal of catheters.

Results: We report on a complete and immediate resolution of clinical symptoms, dural gadolinium enhancement and regression of subdural effusions in all patients.

Conclusions: In our opinion, the administration of an extensive blood patch by two surgically placed epidural catheters is a simple, well tolerated and highly effective treatment of intracranial hypotension, even in patients with a delayed course in the presence of subdural effusions.