Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose An epidural blood patch (EBP) is a highly effective therapy for spinal cerebrospinal fluid (CSF) leakage. However, the factors predicting the response to an EBP have not been fully elucidated. The aim of this study was to elucidate factors predicting the response to an EBP. Methods We retrospectively examined the relationship between the response to an EBP and clinical variables of 118 patients with spinal CSF leakage, such as patient age, sex, etiology, interval from the onset to EBP application, CSF opening pressure (OP), radioisotope (RI) cisternography findings, rate of RI remaining in the CSF space, computed tomography (CT) myelography findings, magnetic resonance imaging (MRI) findings, and subjective symptoms (headache, vertigo/dizziness, visual disturbance, nausea, numbness, nuchal pain, back pain/lumbago, fatigability, photophobia, and memory disturbance). The correlations between these variables and the responses to EBPs were analyzed statistically. Results A positive response to an EBP was significantly (p<0.05) correlated with the following variables: <1.5 years from the onset to EBP application, age <40 years, CSF OP <7 cm H2O, epidural CSF leakage in RI cisternography, epidural CSF collection in MRI, <20% RI remaining after 24 hours, orthostatic headache, nausea, nuchal pain, and photophobia. The other variables did not show significant correlations with the responses to EBPs. Conclusions It might be prudent to take the following variables into account when applying an EBP to treat spinal CSF leakage: the interval from the onset to EBP application, age, CSF OP, epidural CSF leakage in RI, epidural CSF collection in MRI, rate of remaining RI, orthostatic headache, nuchal pain, photophobia, and nausea.
Abstract
Background and Purpose An epidural blood patch (EBP) is a highly effective therapy for spinal cerebrospinal fluid (CSF) leakage. However, the factors predicting the response to an EBP have not been fully elucidated. The aim of this study was to elucidate factors predicting the response to an EBP. Methods We retrospectively examined the relationship between the response to an EBP and clinical variables of 118 patients with spinal CSF leakage, such as patient age, sex, etiology, interval from the onset to EBP application, CSF opening pressure (OP), radioisotope (RI) cisternography findings, rate of RI remaining in the CSF space, computed tomography (CT) myelography findings, magnetic resonance imaging (MRI) findings, and subjective symptoms (headache, vertigo/dizziness, visual disturbance, nausea, numbness, nuchal pain, back pain/lumbago, fatigability, photophobia, and memory disturbance). The correlations between these variables and the responses to EBPs were analyzed statistically. Results A positive response to an EBP was significantly (p<0.05) correlated with the following variables: <1.5 years from the onset to EBP application, age <40 years, CSF OP <7 cm H2O, epidural CSF leakage in RI cisternography, epidural CSF collection in MRI, <20% RI remaining after 24 hours, orthostatic headache, nausea, nuchal pain, and photophobia. The other variables did not show significant correlations with the responses to EBPs. Conclusions It might be prudent to take the following variables into account when applying an EBP to treat spinal CSF leakage: the interval from the onset to EBP application, age, CSF OP, epidural CSF leakage in RI, epidural CSF collection in MRI, rate of remaining RI, orthostatic headache, nuchal pain, photophobia, and nausea.
참고문헌 (27)
- Schievink WI, "Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension", JAMA, 295, pp.2286~2296 (2006)
- Mokri B, "Spontaneous low pressure, low CSF volume headaches : spontaneous CSF leaks", Headache, 53, pp.1034~1053 (2013)
- Mokri B, "Absent headache despite CSF volume depletion (intracranial hypotension)", Neurology, 55, pp.1722~1724 (2000)
- Schievink WI, "Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension", AJNR Am J Neuroradiol, 29, pp.853~856 (2008)
- Mokri B, "Wolff’s Headache and Other Head Pain", pp.513~531 (2000), Oxford University Press
- Horton JC, "Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak", Ophthalmology, 101, pp.244~251 (1994)
- Brady-McCreery KM, "Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies", Binocul Vis Strabismus Q, 17, pp.43~48 (2002)
- Ferrante E, "Transient oculomotor cranial nerves palsy in spontaneous intracranial hypotension", J Neurosurg Sci, 42, pp.177~179 (1998)
- Nowak DA, "Broadening the clinical spectrum : unusual presentation of spontaneous cerebrospinal fluid hypovolemia", J Neurosurg, 98, pp.903~907 (2003)
- Hong M, "Spontaneous intracranial hypotension causing reversible frontotemporal dementia", Neurology, 58, pp.1285~1287 (2002)
- Wicklund MR, "Frontotemporal brain sagging syndrome : an SIH-like presentation mimicking FTD", Neurology, 76, pp.1377~1382 (2011)
- Schievink WI, "Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension", J Neurosurg, 84, pp.598~605 (1996)
- Pannullo SC, "MRI changes in intracranial hypotension", Neurology, 43, pp.919~926 (1993)
- Akbar JJ, "The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension", AJNR Am J Neuroradiol, 33, pp.535~540 (2012)
- Duffy PJ, "The epidural blood patch. Resolving the controversies", Can J Anaesth, 46, pp.878~886 (1999)
- Sencakova D, "The efficacy of epidural blood patch in spontaneous CSF leaks", Neurology, 57, pp.1921~1923 (2001)
- Karm MH, "Predictors of the treatment response of spontaneous intracranial hypotension to an epidural blood patch", Medicine(Baltimore), 95, pp.e3578~ (2016)
- Wu JW, "Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension", Brain, 140, pp.344~352 (2017)
- Schievink WI, "Spontaneous spinal cerebrospinal fluid leaks", Cephalalgia, 28, pp.1345~1356 (2008)
- Mokri B, "Headaches caused by decreased intracranial pressure : diagnosis and management", Curr Opin Neurol, 16, pp.319~326 (2003)
- Cho KI, "Spontaneous intracranial hypotension : efficacy of radiologic targeting vs blind blood patch", Neurology, 76, pp.1139~1144 (2011)
- Gibson BE, "Continuous epidural saline infusion for the treatment of low CSF pressure headache", Anesthesiology, 68, pp.789~791 (1988)
- Crul BJ, "Epidural fibrin glue injection stops persistent postdural puncture headache", Anesthesiology, 91, pp.576~577 (1999)
- Franzini A, "Spontaneous intracranial hypotension syndrome : a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients", J Neurosurg, 112, pp.300~306 (2010)
- Spelle L, "Neuroimaging features of spontaneous intracranial hypotension", Neuroradiology, 43, pp.622~627 (2001)
- Joo EY, "Retrospective study of epidural blood patch use for spontaneous intracranial hypotension", Reg Anesth Pain Med, 40, pp.58~61 (2015)
- Moriyama E, "Quantitative analysis of radioisotope cisternography in the diagnosis of intracranial hypotension", J Neurosurg, 101, pp.421~426 (2004)