Endoscopic Repair of Cerebrospinal Fluid Leak.

Neurosurgery practice Pub Date : 2024-06-11 eCollection Date: 2024-09-01 DOI:10.1227/neuprac.0000000000000093
Lindsey Schwartz, Ismail Mohiuddin, Sibi Rajendran, Meng Huang
{"title":"Endoscopic Repair of Cerebrospinal Fluid Leak.","authors":"Lindsey Schwartz, Ismail Mohiuddin, Sibi Rajendran, Meng Huang","doi":"10.1227/neuprac.0000000000000093","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and importance: </strong>The evolution of endoscopic techniques in spine has allowed novel approaches to various pathologies. We describe the use of endoscopy for repair of refractory cerebrospinal fluid (CSF) leak after lumbar puncture (LP).</p><p><strong>Clinical presentation: </strong>A 31-year-old female presented with refractory postural headaches after undergoing LP. The patient underwent 4 total epidural blood patches (EBPs) with minimal symptomatic relief. The LP opening pressure was found to be 18 cm of water, inconsistent with underlying pseudotumor cerebri. A myelogram demonstrated persistent CSF leak and contrast accumulation within the dorsal epidural space at L2-3. Endoscopic exploration was ultimately performed, which demonstrated well-placed EBPs; however, continuous CSF egressed from a pinhole site. This was repaired with coagulation using a radiofrequency probe, DuraSeal (Integra LifeSciences) and DuraGen (Integra LifeSciences). Postoperatively, the patient noted resolution of debilitating intracranial hypotension symptoms and was able to return to work.</p><p><strong>Conclusion: </strong>Postdural puncture headaches occur in about 1/3 of patients after LP. Symptoms are often debilitating and can include nausea, neck pain, dizziness, tinnitus, visual changes, and hearing loss. Multiple pharmacological and invasive treatments, such as EBP, have been used historically with success, but Postdural puncture headaches refractory to these interventions can put patients at risk for serious complications including seizures and subdural hematomas. We present the first reported case of an endoscopic approach to repair refractory CSF leak in the lumbar spine. Our approach highlights the potential of minimally invasive endoscopic techniques in the repair of refractory CSF leak from the puncture site after LP.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00093"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783657/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1227/neuprac.0000000000000093","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background and importance: The evolution of endoscopic techniques in spine has allowed novel approaches to various pathologies. We describe the use of endoscopy for repair of refractory cerebrospinal fluid (CSF) leak after lumbar puncture (LP).

Clinical presentation: A 31-year-old female presented with refractory postural headaches after undergoing LP. The patient underwent 4 total epidural blood patches (EBPs) with minimal symptomatic relief. The LP opening pressure was found to be 18 cm of water, inconsistent with underlying pseudotumor cerebri. A myelogram demonstrated persistent CSF leak and contrast accumulation within the dorsal epidural space at L2-3. Endoscopic exploration was ultimately performed, which demonstrated well-placed EBPs; however, continuous CSF egressed from a pinhole site. This was repaired with coagulation using a radiofrequency probe, DuraSeal (Integra LifeSciences) and DuraGen (Integra LifeSciences). Postoperatively, the patient noted resolution of debilitating intracranial hypotension symptoms and was able to return to work.

Conclusion: Postdural puncture headaches occur in about 1/3 of patients after LP. Symptoms are often debilitating and can include nausea, neck pain, dizziness, tinnitus, visual changes, and hearing loss. Multiple pharmacological and invasive treatments, such as EBP, have been used historically with success, but Postdural puncture headaches refractory to these interventions can put patients at risk for serious complications including seizures and subdural hematomas. We present the first reported case of an endoscopic approach to repair refractory CSF leak in the lumbar spine. Our approach highlights the potential of minimally invasive endoscopic techniques in the repair of refractory CSF leak from the puncture site after LP.

脑脊液漏的内窥镜修复。
背景和重要性:脊柱内窥镜技术的发展为各种病理提供了新的途径。我们描述使用内窥镜修复难治性脑脊液(CSF)泄漏后腰椎穿刺(LP)。临床表现:一位31岁的女性在LP手术后出现难治性体位性头痛。患者接受了4次全硬膜外血液贴片(ebp),症状得到轻微缓解。LP开口压力为18 cm水,与颅底假性肿瘤不一致。脊髓造影显示L2-3脊膜外背腔持续脑脊液渗漏和造影剂积聚。最终进行了内镜探查,发现ebp位置良好;然而,连续的脑脊液从针孔部位流出。使用射频探针DuraSeal (Integra LifeSciences)和DuraGen (Integra LifeSciences)进行凝固修复。术后,患者注意到衰弱性颅内低血压症状的缓解,并能够重返工作岗位。结论:硬脊膜穿刺后头痛发生率约为1/3。症状通常使人虚弱,包括恶心、颈部疼痛、头晕、耳鸣、视觉变化和听力丧失。多种药物和侵入性治疗,如EBP,在历史上已经取得了成功,但硬脊膜后穿刺头痛对这些干预措施的难治性可能使患者面临严重并发症的风险,包括癫痫发作和硬脊膜下血肿。我们提出了第一个报告的病例内镜入路修复难治性脑脊液泄漏在腰椎。我们的方法强调了微创内窥镜技术在LP后从穿刺部位修复难治性脑脊液泄漏的潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信