title: Post dural puncture headache following intrathecal drug delivery system placement.
abstract: BACKGROUND
  Placement of an intrathecal drug delivery system (IDDS) may provide substantial benefit to certain patients. However, placement of these devices is not without complications, and minimal data exist describing the rates of these complications. Specifically, there is a paucity of data describing the incidence of post dural puncture headache (PDPH) following IDDS placement.
  
  
  OBJECTIVE
  The aim of this study was to identify the incidence and treatment course of PDPH following placement of an IDDS in a retrospective review.
  
  
  METHODS
  Retrospective assessment of medical records.
  
  
  METHODS
  Department of Pain Medicine and Anesthesiology, Mayo Clinic, Rochester, MN.
  
  
  METHODS
  Following IRB approval, 319 IDDS surgical reports in 285 patients were identified retrospectively over a 20 year study time period. We report demographic information, number of dural punctures, techniques for sealing dural leak, details, and treatment course of PDPH in this population.
  
  
  RESULTS
  Symptoms of PDPH were recognized in 73 individual cases (23% of total procedural volume). Younger patient age was the only statistically significant characteristic in predicting development of a PDPH. There were no statistically significant differences found in regards to other risk factors for PDPH development or treatment strategy employed. Seventy-nine percent of PDPH patients were successfully managed with conservative non-interventional therapies (bedrest, IV fluids, analgesics, antiemetics), while 21% required progression to epidural blood or fibrin glue patch procedures for full resolution of symptoms.
  
  
  CONCLUSIONS
  Limitations include the retrospective design of the study as well as the potential for undocumented or improperly documented surgical techniques and/or events.
  
  
  CONCLUSIONS
  Though the development of PDPH after IDDS implantation was found to be fairly common (23% incidence), the majority of these patients had self-limited symptoms that resolved with conservative medical management. Epidural blood patch or application of epidural fibrin glue was therapeutically successful for the remainder of PDPH patients who were refractory to conservative measures.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA. saneuman@gundluth.org
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Neuman
authors.forename: Jason S
authors.initials: JS
authors.lastname: Eldrige
authors.forename: Wenchun
authors.initials: W
authors.lastname: Qu
authors.forename: Eric D
authors.initials: ED
authors.lastname: Freeman
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Hoelzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D051299:Post-Dural Puncture Headache / Q000453:epidemiology*; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000700:Analgesics; D009125:Muscle Relaxants, Central