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CSF leak / blood patch difficultiy
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CSF leak / blood patch difficultiy


  I have a spontaneous CSF leak, the location of which was documented by CT
  myelography, in the thoracic spine. The condition began in Dec 97 with a
  prolonged migraine, and was ultimately diagnosed by spinal tap as low
  pressure headache. Epidural blood patch has been attempted twice.
  Problem is relative to blood patch. The anesthesiologist uses a fluoroscope.
  The first time I was laying flat. It took 6 attempts to insert needle into
  epidural space (in the neighborhood of T-3) without entering a blood vessel
  (that would sweep away the patch). (The sixth / successful insertion was
  going straight in, as opposed to entering on one of the sides, MRI / CT
  films showed leak to be on belly side), (I believe he refereed to this
  condition as hypervascularity). The patch didn't take. The second time,
  the anesthesiologist had me lay on my side (in an effort to change the
  vascular structure in the epidural space). This single attempt initially
  appeared to be well positioned, but while injecting blood, fluoroscope
  showed some sweeping away again. That patch didn't take.
  I am now scheduled for a third attempt in mid-sept. Anesthesiologist spoke
  of trying higher (T-1 or so).   Any ideas as to: 1) cause /effect of thi
  s profusion of vessels ?, 2) with this in mind, how to achieve a successful
  patch (giving it a chance to work) with this apparently unusual profusion
  of vessels ? 3) any relationship of CSF leak to hypervascularity ?
  If patch fails again, long term consequences from long term low pressure ?
  Thanks.
________
________
Dear W.W.,
Tough problem.  If the blood patches don't work, your physicians may consider
admitting you to the hospital for a lumbar subarachnoid drain.  A catheter
is placed in the lumbar spinal sac to drain CSF and 'take the heat' off the
site that is leaking spinal fluid, allowing it to heal.  They may need to keep
the drain in for 3-5 days of CSF drainage.  This is often a useful option.  
If this fails, then a surgeon would want to confirm the site of the leak and
possibly attempt an open repair of the leak.
Ask your physician about these things and see whether he doesn't agree.
Good luck.







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