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Published on: May 26, 2023
CT-guided percutaneous translaminar approach for blood patching: case report and technical note
Sait Albayram1, Bashar Abuzayed, Zehra Isik Hasiloglu
1Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, PO Box: 34089, Cerrahpasa Street, Koca M. Pasa, Istanbul, Turkey. salbayram@hotmail.com
Summary
A novel CT-guided translaminar epidural blood patch (EBP) technique offers a solution for challenging cases. This minimally invasive approach successfully treated CSF leakage in a patient with complex spinal anatomy.
Area of Science:
- Neurosurgery
- Radiology
- Anesthesiology
Background:
- Post-dural puncture headache (PDPH) can occur after spinal procedures.
- Epidural blood patch (EBP) is a common treatment for PDPH.
- Challenging spinal anatomy can impede traditional interlaminar EBP approaches.
Observation:
- A patient with a history of multiple spinal surgeries presented with severe orthostatic headaches and confirmed CSF leakage.
- Conventional fluoroscopic and CT-guided interlaminar EBP attempts failed due to spinal instrumentation and bony abnormalities.
- A novel percutaneous CT-guided translaminar approach was utilized.
Findings:
- The translaminar EBP technique successfully sealed the CSF leak at the T3 vertebral level.
- The procedure was performed without complications using an Ostycut trephine needle.
- This approach navigated complex spinal anatomy, overcoming limitations of the interlaminar route.
Implications:
- This novel translaminar technique expands EBP treatment options for patients with complex spinal conditions.
- CT guidance enhances precision in challenging epidural interventions.
- Minimally invasive techniques improve patient outcomes in neurosurgical and pain management procedures.