The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage

Can Ozutemiz, Yasemin Kocabaş Köksel, Haitao Huang, Nathan T Rubin, Jeffrey B Rykken

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate patient outcomes following fluoroscopy-guided epidural blood patch (FGEBP), factors affecting the outcome, and to identify the rate of fluoroscopy-guided lumbar punctures (FGLP) requiring FGEBP. Methods: All FGLPs and FGEBPs between January 2014 and May 2017 were retrospectively evaluated. Information regarding patient characteristics, details of previous dural puncture (DP), details of the FGEBP, and FGEBP outcome were recorded. The outcome was classified into three categories as “complete response”, “partial response”, and “no response”. Patients with “complete response” were compared to the combined group of “no response” and “partial response”, classified as “incomplete response”. Two-sample/Fisher’s exact (continued/categorical variables) tests were used (p < 0.05). Results: Sity-seven FGEBPs were performed in 63 patients (female/male, 36/27; mean age/BMI 38/28.2). Fifty-nine were referred following DP; 31 were performed by radiologists. The rate of FGLPs requiring FGEBP was 1.78% within 3.5 years. The mean DP-FGEBP interval was 4.8 days. “Complete response” was achieved in 56 (84.8%), “no response” was found following 4 (6%) procedures. Average applied blood volume was 16 cc (5–30 cc). No difference was found between “complete response” and “incomplete response” groups regarding age, sex, BMI, DP performer, DP level, DP fluoroscopy time, DP needle caliber/type, FGEBP level, FGEBP needle caliber/type, FGEBP fluoroscopy time, FGEBP performer, and applied blood volume (p > 0.05). Despite approaching significance, no statistically significant difference was found regarding the presence of previous DP (p = 0.06). Conclusions: The efficacy of FGEBP is high in a group of patients referred to radiology for treatment of CSF leakage with complete response in 84.8% of patients. Key Points: • Fluoroscopy-guided epidural blood patch completely resolved symptoms in 85% of post-dural puncture headaches. • The success approaches 95% when including the patients with partial resolution of symptoms. • Epidural blood patch rate is found 1.8% following 1703 fluoroscopy-guided lumbar punctures.

Original languageEnglish (US)
Pages (from-to)4088-4095
Number of pages8
JournalEuropean Radiology
Volume29
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Epidural Blood Patch
Fluoroscopy
Spinal Puncture
Therapeutics
Punctures
Post-Dural Puncture Headache
Cerebrospinal Fluid Leak
Radiology

Keywords

  • Epidural blood patch
  • Fluoroscopy
  • Intracranial hypotension
  • Lumbar puncture
  • Post-dural puncture headache

Cite this

The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage. / Ozutemiz, Can; Köksel, Yasemin Kocabaş; Huang, Haitao; Rubin, Nathan T; Rykken, Jeffrey B.

In: European Radiology, Vol. 29, No. 8, 01.08.2019, p. 4088-4095.

Research output: Contribution to journalArticle

@article{6250a9f18da5474d883f865ae1e8de73,
title = "The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage",
abstract = "Objective: To evaluate patient outcomes following fluoroscopy-guided epidural blood patch (FGEBP), factors affecting the outcome, and to identify the rate of fluoroscopy-guided lumbar punctures (FGLP) requiring FGEBP. Methods: All FGLPs and FGEBPs between January 2014 and May 2017 were retrospectively evaluated. Information regarding patient characteristics, details of previous dural puncture (DP), details of the FGEBP, and FGEBP outcome were recorded. The outcome was classified into three categories as “complete response”, “partial response”, and “no response”. Patients with “complete response” were compared to the combined group of “no response” and “partial response”, classified as “incomplete response”. Two-sample/Fisher’s exact (continued/categorical variables) tests were used (p < 0.05). Results: Sity-seven FGEBPs were performed in 63 patients (female/male, 36/27; mean age/BMI 38/28.2). Fifty-nine were referred following DP; 31 were performed by radiologists. The rate of FGLPs requiring FGEBP was 1.78{\%} within 3.5 years. The mean DP-FGEBP interval was 4.8 days. “Complete response” was achieved in 56 (84.8{\%}), “no response” was found following 4 (6{\%}) procedures. Average applied blood volume was 16 cc (5–30 cc). No difference was found between “complete response” and “incomplete response” groups regarding age, sex, BMI, DP performer, DP level, DP fluoroscopy time, DP needle caliber/type, FGEBP level, FGEBP needle caliber/type, FGEBP fluoroscopy time, FGEBP performer, and applied blood volume (p > 0.05). Despite approaching significance, no statistically significant difference was found regarding the presence of previous DP (p = 0.06). Conclusions: The efficacy of FGEBP is high in a group of patients referred to radiology for treatment of CSF leakage with complete response in 84.8{\%} of patients. Key Points: • Fluoroscopy-guided epidural blood patch completely resolved symptoms in 85{\%} of post-dural puncture headaches. • The success approaches 95{\%} when including the patients with partial resolution of symptoms. • Epidural blood patch rate is found 1.8{\%} following 1703 fluoroscopy-guided lumbar punctures.",
keywords = "Epidural blood patch, Fluoroscopy, Intracranial hypotension, Lumbar puncture, Post-dural puncture headache",
author = "Can Ozutemiz and K{\"o}ksel, {Yasemin Kocabaş} and Haitao Huang and Rubin, {Nathan T} and Rykken, {Jeffrey B}",
year = "2019",
month = "8",
day = "1",
doi = "10.1007/s00330-018-5828-x",
language = "English (US)",
volume = "29",
pages = "4088--4095",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "8",

}

TY - JOUR

T1 - The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage

AU - Ozutemiz, Can

AU - Köksel, Yasemin Kocabaş

AU - Huang, Haitao

AU - Rubin, Nathan T

AU - Rykken, Jeffrey B

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objective: To evaluate patient outcomes following fluoroscopy-guided epidural blood patch (FGEBP), factors affecting the outcome, and to identify the rate of fluoroscopy-guided lumbar punctures (FGLP) requiring FGEBP. Methods: All FGLPs and FGEBPs between January 2014 and May 2017 were retrospectively evaluated. Information regarding patient characteristics, details of previous dural puncture (DP), details of the FGEBP, and FGEBP outcome were recorded. The outcome was classified into three categories as “complete response”, “partial response”, and “no response”. Patients with “complete response” were compared to the combined group of “no response” and “partial response”, classified as “incomplete response”. Two-sample/Fisher’s exact (continued/categorical variables) tests were used (p < 0.05). Results: Sity-seven FGEBPs were performed in 63 patients (female/male, 36/27; mean age/BMI 38/28.2). Fifty-nine were referred following DP; 31 were performed by radiologists. The rate of FGLPs requiring FGEBP was 1.78% within 3.5 years. The mean DP-FGEBP interval was 4.8 days. “Complete response” was achieved in 56 (84.8%), “no response” was found following 4 (6%) procedures. Average applied blood volume was 16 cc (5–30 cc). No difference was found between “complete response” and “incomplete response” groups regarding age, sex, BMI, DP performer, DP level, DP fluoroscopy time, DP needle caliber/type, FGEBP level, FGEBP needle caliber/type, FGEBP fluoroscopy time, FGEBP performer, and applied blood volume (p > 0.05). Despite approaching significance, no statistically significant difference was found regarding the presence of previous DP (p = 0.06). Conclusions: The efficacy of FGEBP is high in a group of patients referred to radiology for treatment of CSF leakage with complete response in 84.8% of patients. Key Points: • Fluoroscopy-guided epidural blood patch completely resolved symptoms in 85% of post-dural puncture headaches. • The success approaches 95% when including the patients with partial resolution of symptoms. • Epidural blood patch rate is found 1.8% following 1703 fluoroscopy-guided lumbar punctures.

AB - Objective: To evaluate patient outcomes following fluoroscopy-guided epidural blood patch (FGEBP), factors affecting the outcome, and to identify the rate of fluoroscopy-guided lumbar punctures (FGLP) requiring FGEBP. Methods: All FGLPs and FGEBPs between January 2014 and May 2017 were retrospectively evaluated. Information regarding patient characteristics, details of previous dural puncture (DP), details of the FGEBP, and FGEBP outcome were recorded. The outcome was classified into three categories as “complete response”, “partial response”, and “no response”. Patients with “complete response” were compared to the combined group of “no response” and “partial response”, classified as “incomplete response”. Two-sample/Fisher’s exact (continued/categorical variables) tests were used (p < 0.05). Results: Sity-seven FGEBPs were performed in 63 patients (female/male, 36/27; mean age/BMI 38/28.2). Fifty-nine were referred following DP; 31 were performed by radiologists. The rate of FGLPs requiring FGEBP was 1.78% within 3.5 years. The mean DP-FGEBP interval was 4.8 days. “Complete response” was achieved in 56 (84.8%), “no response” was found following 4 (6%) procedures. Average applied blood volume was 16 cc (5–30 cc). No difference was found between “complete response” and “incomplete response” groups regarding age, sex, BMI, DP performer, DP level, DP fluoroscopy time, DP needle caliber/type, FGEBP level, FGEBP needle caliber/type, FGEBP fluoroscopy time, FGEBP performer, and applied blood volume (p > 0.05). Despite approaching significance, no statistically significant difference was found regarding the presence of previous DP (p = 0.06). Conclusions: The efficacy of FGEBP is high in a group of patients referred to radiology for treatment of CSF leakage with complete response in 84.8% of patients. Key Points: • Fluoroscopy-guided epidural blood patch completely resolved symptoms in 85% of post-dural puncture headaches. • The success approaches 95% when including the patients with partial resolution of symptoms. • Epidural blood patch rate is found 1.8% following 1703 fluoroscopy-guided lumbar punctures.

KW - Epidural blood patch

KW - Fluoroscopy

KW - Intracranial hypotension

KW - Lumbar puncture

KW - Post-dural puncture headache

UR - http://www.scopus.com/inward/record.url?scp=85056328191&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056328191&partnerID=8YFLogxK

U2 - 10.1007/s00330-018-5828-x

DO - 10.1007/s00330-018-5828-x

M3 - Article

VL - 29

SP - 4088

EP - 4095

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 8

ER -