Initial Results of Precision Treatment of Postoperative Cerebrospinal Fluid Leak with Ultrasound-Guided Epidural Blood Patch

xlomafota13 shared this article with you from Inoreader Initial Results of Precision Treatment of Postoperative Cerebrospinal Fluid Leak with Ultrasound-Guided Epidural Blood Patch Via leak of cerebrospinal fluid World Neurosurg. 2021 Jun 24:S1878-8750(21)00931-1. doi: 10.1016/j.wneu.2021.06.090. Online ahead of print. ABSTRACT BACKGROUND: Incidental durotomy, a known complication of spinal surgery, can lead to persistent cerebrospinal fluid (CSF) leak and pseudomeningocele if unrecognized or incompletely repaired. In this manuscript, we describe the use of ultrasound to visualize the site of durotomy, observe the aspiration of the pseudomeningocele, and guide the precise application of an EBP, under direct visualization in real time (US-EBP). METHODS: A retrospective review was performed to determine demographic, procedural, and outcome characteristics for patients who underwent US-EBP for symptomatic postoperative pseudomeningocele. RESULTS: Overall, 48 patients who underwent 49 unique episodes of care were included. The average age and BMI were 60.5 (+ 12.6) years and 27.8 (+ 4.50) kg/m2, respectively. The most frequent index operation was laminectomy (24.5%) and 36.7% of surgeries were revision operations. Durotomy was intended or recognized in 73.4% of cases, and the median time from surgery to symptom development was 7 (IQR 4-16) days. A total of 61 US-EBPs were performed, with 51.0% of patients experiencing resolution of their symptoms after the first US-EBP. An additional 20.4% were successful with multiple US-EBP attempts. Complications occurred in 14.3% of cases and the median clinical follow-up was 4.3 (IQR 2.4-14.5) months. CONCLUSIONS: This manuscript represents the largest series in the literature describing US-EBP for the treatment of postoperative pseudomeningocele. The success rate suggests that routine utilization of US-guided EBP may allow for targeted treatment of pseudomeningoceles, without the prolonged hospitalization associated with lumbar drains or the risks of general anesthesia and impaired wound healing associated with surgical revision. PMID:34175483 | DOI:10.1016/j.wneu.2021.06.090 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.