Retrospective study of epidural blood patch use for spontaneous intracranial hypotension.

BACKGROUND AND OBJECTIVES: Spontaneous intracranial hypotension (SIH) is characterized by a severe and disabling headache that is usually orthostatic in nature. Cisternography is a useful diagnostic test for evaluating the presence and location of cerebrospinal fluid (CSF) leakage, and a targeted epidural blood patch (EBP) based on the cisternography findings is a very effective treatment modality for SIH. However, the effects of EBPs are not predictable, making repeat EBPs essential in some cases. The aim of the present study was to find the relationship between the EBP response and cisternographic findings, hypothesizing that the number of required EBPs would increase with an increased number of CSF leakage levels as determined by radionuclide cisternography. METHODS: All patients who underwent an EBP and had been discharged with significant improvements in symptoms of SIH during 2006 to 2011 were enrolled. Patients who had no radionuclide cisternographic results were excluded. The demographic variables, number of EBPs, cisternographic findings (location, bilaterality, and number of leakage sites), and preprocedural and postprocedural pain scores were reviewed. RESULTS: There was no correlation found between the cisternographic findings and the number of EBPs. Only the preprocedural pain scores showed a statistically significant correlation with the number of EBPs. CONCLUSIONS: Our study suggests that the response to the EBP is related to the severity of symptoms but not to the number and locations of cisternographic CSF leakages.

A novel balloon-inflatable catheter for percutaneous epidural adhesiolysis and decompression.

Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis.

The comparative study of flow rate between IV extension tube and epidural catheter connected to patient controlled analgesia device.

BACKGROUND: Patient controlled analgesia (PCA) device is known to be an effective method for acute and chronic pain control and the administration route for PCA pump is various. The representative routes are intravenous and epidural space. The aim of this study is to investigate the influence of catheter diameter on flow rate. METHODS: IV extension tube or epidural catheter connected to Mechanical- or balloon-type PCA devices were examined (100 ml, 2 ml/hr). There were four groups each of 5 experiments: Group I: Mechanical-type pump + IV extension tube, Group II: Mechanical-type pump + epidural catheter, Group III: Balloon-type pump + IV extension tube, Group IV: Balloon-type pump + epidural catheter. The flow rate was indirectly measured by the weight change of collecting infusate bottle. Infusion fluid was distilled water. Experiment was carried out in a laboratory room with a constant room temperature of 20-22degrees C. RESULTS: Infusion rate differed significantly among the groups, exhibiting flow rates within +/-15% of their expected rate for 28% (group IV) to 100% (group I) of their infusion duration. The mean Infusion rate in group I was significantly more rapid than that in other groups. The mean flow rate in group III was higher than that in group IV (P<0.05). CONCLUSIONS: These results indicate that the use of an epidural catheter with a small internal diameter could decrease the flow rate of PCA device.