PubMed · 7505608
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J A Aldrete. Epidural dextran for PDPH.. https://pubmed.ncbi.nlm.nih.gov/7505608/
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This clinical report describes the performance of an epidural blood patch in a four-year-old child with acute lymphocytic leukaemia, who developed a subarachnoid-cutaneous fistula from repeated lumbar punctures for chemotherapy. The epidural blood patch was performed using an #18-gauge epidural catheter threaded through a #16-gauge intravenous catheter via the caudal approach. This approach was successful in a child whose lumbar epidural anatomy was distorted due to a collection of subcutaneous cerebrospinal fluid making identification of the epidural space by the usual lumbar approach very difficult. This report demonstrates an alternative technique for the performance of an epidural blood patch.
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Our goal was to determine if evidence of cerebrospinal fluid (CSF) leakage on routine postmyelogram computed tomography (CT) of the lumbar spine was useful in predicting subsequent development of moderate or severe headaches in patients having outpatient myelography. We reviewed postmyelogram CT studies of the lower lumbar region of 89 patients for radiographic indication of CSF leakage. These patients had outpatient lumbar myelography. We conducted telephone interviews to determine whether a postmyelographic headache occurred. Correlation of CT-verifiable contrast leakage with subsequent development of postmyelogram headache was statistically significant. The early radiographic identification of such patients affords the opportunity for additional measures, such as extended bed confinement, to decrease the morbidity of myelography. Additionally, statistical correlation of such findings should provide an objective method of evaluating the effectiveness of alterations in myelographic technique.