J Cerebrovasc Endovasc Neurosurg.  2015 Dec;17(4):318-323. 10.7461/jcen.2015.17.4.318.

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

• Tanweer O
• Kalhorn SP
• Snell JT
• Wilson TA
• Lieber BA
• Agarwal N
• Huang PP
• Sutin KM

• KMID: 2150970
• DOI: http://doi.org/10.7461/jcen.2015.17.4.318

Abstract

Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.

Keyword

Intracranial aneurysm; Intracranial hypotension; Cerebrospinal fluid leakage; Epidural blood patch

MeSH Terms

Blood Patch, Epidural*
Cerebrospinal Fluid*
Drainage*
Intracranial Aneurysm*
Intracranial Hypotension*
Retrospective Studies*

Figure

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  Fig. 1 Case 1. A non-contrast head computed tomography reveals left epidural air and fluid collection along the frontotemporal convexity, slit-like ventricles, and mild left to right midline shift. Not shown is decreased patency of basal cisterns and an oblong midbrain.

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  Fig. 2 Case 2. (A) Non-contrast head computed tomography (CT) showing midline shift and an air collection in the right epidural space subjacent to the craniotomy site. (B) This anterior-posterior projection following injection of contrast into the right vertebral artery reveals kinking of the basilar artery above the vertebro-basilar junction (arrow), "cobra sign", and this is consistent with brain sag. (C) Non-contrast head CT reveals an oval shaped midbrain with obliteration of the basilar cisterns (arrow), a sign of brain sag.

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  Fig. 3 Case 3. Non-contrast head computed tomography demonstrates herniation of the left cerebellar tonsil through the foramen magnum (arrow).

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