title: Ventral Spontaneous Durotomy Following Vaginal Delivery.
abstract: BACKGROUND
  Dural breaches have a diverse etiology, including spontaneous rupture and trauma. Most cases resolve with bed rest; in refractory cases, an epidural blood patch can be placed to obstruct further leakage. We discuss a unique case of a spontaneous ventral durotomy following vaginal delivery that was managed with injections of autologous blood through bilateral transforaminal needles.
  
  
  METHODS
  A previously healthy, 36-year-old pregnant woman presented to the inpatient maternity ward with positional occipital headaches and neck pain 24 hours after normal spontaneous vaginal delivery. Two dorsally placed epidural blood patches provided only transient relief. Computed tomography myelography revealed ventral cerebrospinal fluid leak. Targeted therapy was provided with computed tomography-guided ventral placement of a blood patch.
  
  
  CONCLUSIONS
  Spontaneous durotomy is a rare phenomenon and should be considered in patients who present with positional headaches. Ventrally targeted therapy via an epidural blood patch should be considered to provide optimal relief.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Kashkoush
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Arpan V
authors.initials: AV
authors.lastname: Prabhu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: sekularf@upmc.edu.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Sekula
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000209:etiology* / Q000601:surgery; D004388:Dura Mater; D005260:Female; D020773:Headache Disorders / Q000209:etiology; D020199:Hematoma, Subdural, Acute / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology / Q000601:surgery*; D007744:Obstetric Labor Complications / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology / Q000601:surgery*; D012422:Rupture, Spontaneous / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps
keywords: Cerebrospinal fluid leak; Delivery; Intracranial hypotension; Pregnancy; Spontaneous durotomy