title: Targeted epidural patch with n-butyl cyanoacrylate (n-BCA) through a single catheter access site for treatment of a cerebral spinal fluid leak causing spontaneous intracranial hypotension.
abstract: Spontaneous intracranial hypotension (SIH) usually occurs in the setting of a spontaneous cerebral spinal fluid (CSF) leak. We report the first description of a case of SIH caused by a CSF leak which improved after a targeted epidural patch with n-butyl cyanoacrylate (n-BCA) at the right T1-T2 level. An 81-year-old woman presented with an orthostatic headache for 6 days. MRI of the brain with contrast demonstrated low lying cerebellar tonsils, an engorged transverse sinus flow void, bifrontal small subdural fluid collections, and diffuse dural enhancement. CT myelography showed extravasation of intrathecal contrast at the right T1-T2 level. A targeted epidural patch was performed by injection of n-BCA through a catheter at the right T1-T2 level. After treatment, the patient's symptoms immediately improved and she was without a headache at 1-year follow-up.
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Woolen
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
mesh_terms: D000369:Aged, 80 and over; D017217:Blood Patch, Epidural / Q000379:methods*; D057785:Catheters; D065634:Cerebrospinal Fluid Leak / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D004659:Enbucrilate; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009192:Myelography; D014057:Tomography, X-Ray Computed; D062666:Vascular Access Devices
chemical_list: D004659:Enbucrilate
keywords: Catheter; Epidural; Liquid Embolic Material; Spine