Treatment outcomes of epidural blood patch guided by a novel overflow leak test with computed tomography myelography in patients with intracranial hypotension: a case series.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
Eiichi Nakai, Hitoshi Fukuda, Hajime Kuroiwa, Yu Kawanishi, Tomohito Kadota, Tetsuya Ueba
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引用次数: 0

Abstract

Objective: To describe the treatment outcomes of epidural blood patch (EBP) guided by a novel overflow leak test (OLT) combined with computed tomography myelography (CTM) in patients with intracranial hypotension, with focus on consistency and discrepancy between CTM and OLT findings METHODS: CTM followed by OLT was performed in 18 adults with a CSF pressure of ≤60 mmH2O. Patients were categorized according to consistency or discrepancy between CTM and OLT findings: Group A, matching leak signals in CTM and OLT; Group B, leak signals detected by OLT only; Group C, discrepancy in leak signal sites between CTM and OLT; Group D, no leak signal detected by both CTM and OLT. EBPs were applied according to the treatment policy, and associations between the radiological categorization and treatment outcomes were determined. Thereafter, using CT and magnetic resonance imaging phantoms, we investigated the minimal amount of injected agent leaking from the lumbar puncture site visible, which could result in a false-positive signal in CTM and OLT.

Results: Complete recovery following EBP was achieved for 13 (72%) patients; these included 50%, 82%, 100%, and 0% patients in Groups A, B, C, and D, respectively. In CT myelography phantoms, even 1 μL of contrast agent produced positive findings, whereas OLT phantoms required a minimum of 1,000 μL.

Conclusions: These results suggest the potential additive diagnostic value of OLT when performed with CTM. The discrepancy in radiological findings could be partly explained by susceptibility to the contrast agent leaking from the lumbar puncture site.

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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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