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The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage

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Abstract

Objective

To evaluate patient outcomes following fluoroscopy-guided epidural blood patch (FGEBP), factors affecting the outcome, and to identify the rate of fluoroscopy-guided lumbar punctures (FGLP) requiring FGEBP.

Methods

All FGLPs and FGEBPs between January 2014 and May 2017 were retrospectively evaluated. Information regarding patient characteristics, details of previous dural puncture (DP), details of the FGEBP, and FGEBP outcome were recorded. The outcome was classified into three categories as “complete response”, “partial response”, and “no response”. Patients with “complete response” were compared to the combined group of “no response” and “partial response”, classified as “incomplete response”. Two-sample/Fisher’s exact (continued/categorical variables) tests were used (p < 0.05).

Results

Sity-seven FGEBPs were performed in 63 patients (female/male, 36/27; mean age/BMI 38/28.2). Fifty-nine were referred following DP; 31 were performed by radiologists. The rate of FGLPs requiring FGEBP was 1.78% within 3.5 years. The mean DP-FGEBP interval was 4.8 days. “Complete response” was achieved in 56 (84.8%), “no response” was found following 4 (6%) procedures. Average applied blood volume was 16 cc (5–30 cc). No difference was found between “complete response” and “incomplete response” groups regarding age, sex, BMI, DP performer, DP level, DP fluoroscopy time, DP needle caliber/type, FGEBP level, FGEBP needle caliber/type, FGEBP fluoroscopy time, FGEBP performer, and applied blood volume (p > 0.05). Despite approaching significance, no statistically significant difference was found regarding the presence of previous DP (p = 0.06).

Conclusions

The efficacy of FGEBP is high in a group of patients referred to radiology for treatment of CSF leakage with complete response in 84.8% of patients.

Key Points

• Fluoroscopy-guided epidural blood patch completely resolved symptoms in 85% of post-dural puncture headaches.

• The success approaches 95% when including the patients with partial resolution of symptoms.

• Epidural blood patch rate is found 1.8% following 1703 fluoroscopy-guided lumbar punctures.

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Abbreviations

BMI:

Body mass index

CSF-OP:

CSF opening pressure

DP:

Dural puncture

EBP:

Epidural blood patch

FGEBP:

Fluoroscopy-guided epidural blood patch

FGLP:

Fluoroscopy-guided lumbar puncture

ICH:

Intracranial hypotension

LP:

Lumbar puncture

PDPH:

Post-dural puncture headache

sICH:

Spontaneous intracranial hypotension

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University of Minnesota, MMC 292, 420 Delaware St. SE, Minneapolis, MN, 55455, USA

    Can Özütemiz, Yasemin Kocabaş Köksel, Haitao Huang & Jeffrey B. Rykken

  2. Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Nathan Rubin

Authors
  1. Can Özütemiz
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  2. Yasemin Kocabaş Köksel
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  3. Haitao Huang
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  4. Nathan Rubin
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  5. Jeffrey B. Rykken
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Corresponding author

Correspondence to Can Özütemiz.

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Guarantor

The scientific guarantor of this publication is Jeffrey B. Rykken.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

Nathan Rubin, MS, from Biostatistics Core, Masonic Cancer Center, University of Minnesota, and Lei Zhang, MS, from Clinical and Translational Science Institute, University of Minnesota, Minneapolis, provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross sectional study

• performed at one institution

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Özütemiz, C., Köksel, Y.K., Huang, H. et al. The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage. Eur Radiol 29, 4088–4095 (2019). https://doi.org/10.1007/s00330-018-5828-x

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