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

Article

Send article

Spinal epidural blood patch as treatment for spontaneous intracranial hypotension caused by CSF-fistula at Th1: Case report

Meeting Abstract

Search Medline for

  • C. Rosenstengel - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • D. Pillich - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • M. Kirsch - Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Greifswald
  • S. Fleck - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • H.W.S. Schroeder - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald

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. DocP11-01

doi: 10.3205/09dgnc364, urn:nbn:de:0183-09dgnc3648

Published: May 20, 2009

© 2009 Rosenstengel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: We report an unusual case of spontaneous intracranial hypotension caused by a spontaneous spinal CSF leak. The patient was successfully treated with a spinal epidural blood patch.

Methods: A 49-year-old woman presented with severe headache and nausea caused by bilateral subdural hematomas (SDH). She underwent bilateral burr-hole evacuation twice. We performed spinal MR imaging in the diagnostic work-up and found an epidural fluid collection along the whole spinal canal. Further evaluation by CT myelography demonstrated the precise position of the CSF fistula at Th1 ventromedially. The patient was successfully treated with an epidural blood patch which was placed under CT guidance.

Results: The initial complaints and neurological deficits resolved completely. The follow-up cranial CT scan 1 month after the blood patch procedure demonstrated complete resolution of the SDH. Furthermore, spinal MR imaging showed a significant fluid reduction in the spinal canal.

Conclusions: In young patients with recurrent cranial SDH, spontaneous intracranial hypotension caused by a spinal CSF fistula should be taken into consideration. An epidural blood patch is the initial procedure of choice in this entity.