title: Fluoroscopically guided epidural blood patch with subsequent spinal CT scans in the treatment of spontaneous cerebrospinal fluid hypovolemia.
abstract: OBJECTIVE
  Recent evidence has indicated that the efficacy of the epidural blood patch (EBP) in the treatment of spontaneous CSF hypovolemia (SCH) is still limited. Therefore, further improvement of the EBP technique is an important clinical challenge. The authors describe a series of cases of SCH treated with fluoroscopically guided placement of an EBP and followed up with subsequent spinal CT scans.
  
  
  METHODS
  Thirteen patients with SCH that was proven on CT myelography studies underwent epidural puncture under fluoroscopic guidance and received an injection of a mixture of contrast medium and autologous blood. Contrast medium was injected to cover the area of CSF leakage during EBP guided by fluoroscopy, and the spread of the blood was subsequently evaluated using spinal CT scanning. If the amount of blood injected was insufficient to cover the leakage area, a second EBP was performed at a later date.
  
  
  RESULTS
  At the first EBP procedure, a mixture with a mean volume of 9.4 ml (range 3-20 ml) was injected, and subsequent spinal CT scans revealed contrast enhancement in the desired epidural space in 12 of 13 patients. In 2 patients, a second EBP was required because of insufficient coverage of the leakage area or delayed recurrence of headache. In all patients, a complete recovery from orthostatic headache was obtained after the last EBP.
  
  
  CONCLUSIONS
  The results indicated that fluoroscopically guided EBP and subsequent spinal CT scans may provide a highly effective therapy in patients with SCH proven on CT myelography studies.
authors.affiliation: Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan. kwatanb@naramed-u.ac.jp
authors.forename: Keisuke
authors.initials: K
authors.lastname: Watanabe
authors.forename: Keiji
authors.initials: K
authors.lastname: Hashizume
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Aki
authors.initials: A
authors.lastname: Fujiwara
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sasaoka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Furuya
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural / Q000379:methods*; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000628:therapy; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006261:Headache / Q000209:etiology / Q000628:therapy*; D006801:Humans; D020896:Hypovolemia / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome