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Targeted epidural blood patch under O-arm-guided stereotactic navigation in patients with intracranial hypotension associated with a spinal CSF leak and ventral dural defect.
World Neurosurg. 2017 Aug 05;:
Authors: Takai K, Taniguchi M
Abstract
OBJECTIVE: Targeted epidural blood patch (EBP) at the site of a presumed cerebrospinal fluid leak reportedly has better outcomes than non-targeted EBP; however, it is associated with a higher risk of wrong-site injection such as iatrogenic subarachnoid or intramuscular injections, which lead to reintervention due to the insufficient coverage of injected blood.
METHODS: Eight patients with intracranial hypotension due to a CSF leak diagnosed by myelographic CT and thin-cut MRI received an epidural blood patch under O-arm-guided stereotactic navigation.
RESULTS: The leak site was identified based on myelographic CT findings of a micro-spur and epidural contrast medium extravasations as well as MRI findings of a ventral dural defect. During the EBP procedure, no iatrogenic dural puncture or subarachnoid injection occurred because O-arm-guided stereotactic navigation provided real-time feedback on the needle trajectory. O-arm CT revealed the sufficient coverage of injected blood following the first injection in six out of eight patients. In the two remaining patients, a second injection was performed during the same session due to insufficient coverage at the previous site. In all patients, complete recovery from orthostatic headaches was achieved after a single session.
CONCLUSIONS: O-arm-guided navigation facilitated EBP by enabling real-time observations of the needle trajectory and distribution of injected blood while simultaneously avoiding major complications such as wrong-site injections or reintervention.
PMID: 28790007 [PubMed - as supplied by publisher]
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