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Epidural blood patch for severe postoperative intracranial hypotension
Leena Mathew1, Ricardo Komotar
1Department of Anesthesiology, Division of Pain Medicine, Columbia University, 622 West 168th Street, New York, NY 10032, USA. lm370@columbia.edu
Journal of Neurosurgical Anesthesiology
|December 25, 2007
Summary
Brain sag, a severe post-craniotomy complication, can cause neurologic decline. An epidural blood patch offers a life-saving intervention for patients unresponsive to conventional treatments, rapidly reversing obtundation.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Brain sag is a rare yet serious postoperative complication following craniotomy.
- It is characterized by severe cerebrospinal fluid hypovolemia, leading to acute neurologic decompensation and obtundation.
- The conventional treatment involves Trendelenburg positioning.
Observation:
- Three cases of severe brain sag with acute neurologic deterioration unresponsive to conventional treatment are presented.
- Patients exhibited signs of herniation and coma despite standard interventions.
- Emergent epidural blood patch was administered to mitigate further neurologic decline.
Findings:
- The epidural blood patch intervention resulted in an immediate and dramatic reversal of obtundation in all three patients.
- This procedure effectively addressed the refractory brain sag.
- Neurologic status improved significantly post-intervention.
Implications:
- Epidural blood patch may serve as a life-saving intervention for post-craniotomy patients with refractory brain sag.
- It should be considered for patients meeting brain sag criteria who do not respond to conventional treatments.
- This approach offers a critical therapeutic option in managing severe postoperative neurological complications.
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