J Neurol Surg A Cent Eur Neurosurg 2012; 73 - P037
DOI: 10.1055/s-0032-1316239

Lack of Increase in Intracranial Pressure after Epidural Blood patch in Spinal Cerebrospinal Fluid Leak

J. F. Fichtner 1, C. F. Fung 1, W.Z. Z‘Graggen 1, A. R. Raabe 1, J. B. Beck 1
  • 1Department of Neurosurgery, Inselspital, Bern, Switzerland

Background and Importance: Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or postlumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP.

Clinical Presentation: This 52-year-old previously healthy man presented with holocephalic headaches. Magnetic resonance imaging showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the EBP (15 cc) the patient improved rapidly; ICP, however, remained unchanged before, during, and after the procedure. One day posttreatment, he had a Glasgow Coma Scale score increase from 12 to 15 and no headache or neurological deficits.

Conclusion: A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal EBP.