Surgical Management of Symptomatic Boxing-Induced Spinal Cerebrospinal Fluid Leak After Failed Epidural Blood Patch
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: Spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized condition responsible for spontaneous intracranial hypotension. A host of connective tissue disorders and mechanical factors may precipitate the condition. Conservative treatment has limited efficacy, and many patients with persistent symptoms ultimately require epidural blood patch (EBP). However, about 23%-44% of patients experience recurrence of symptoms after EBP. Unidentified or multiple sites of CSF leaks are thought to be responsible for the failure of EBP. Using our previously published technique, we treated a patient who developed a large spontaneous CSF leak in her cervicothoracic spine after a boxing class, offering further evidence of the utility of the technique for select patients.
CASE DESCRIPTION: A 28-year-old woman was referred to our center with recurrent, severe headaches and associated nausea and vomiting. She underwent EBP 3 times with no resolution of her symptoms. A right-side partial C7-T1 hemilaminotomy was performed to identify a large meningocele filled with CSF. After dissection, dural sealant was applied using an angled needle with a syringe to buttress the meningocele to allow for normalization of the hydrostatic pressure. At 5-month follow-up, her symptoms have resolved with no headaches and paresthesias in upper limbs.
CONCLUSIONS: Commonplace events, such as a boxing/sparring class, may precipitate a spontaneous spinal CSF leak. Our minimally invasive surgical approach can be safely used in patients with spontaneous intracranial hypotension with recurrent symptoms, no identified leak site, and prior failed attempts of EBP.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:139 |
|---|---|
| Enthalten in: |
World neurosurgery - 139(2020) vom: 10. Juli, Seite 478-482 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Khatri, Deepak [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Boxing |
|---|
| Anmerkungen: |
Date Completed 10.09.2020 Date Revised 10.09.2020 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.wneu.2020.04.194 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM309597498 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM309597498 | ||
| 003 | DE-627 | ||
| 005 | 20231225134246.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.wneu.2020.04.194 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1031.xml |
| 035 | |a (DE-627)NLM309597498 | ||
| 035 | |a (NLM)32376374 | ||
| 035 | |a (PII)S1878-8750(20)30904-9 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Khatri, Deepak |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Surgical Management of Symptomatic Boxing-Induced Spinal Cerebrospinal Fluid Leak After Failed Epidural Blood Patch |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 10.09.2020 | ||
| 500 | |a Date Revised 10.09.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized condition responsible for spontaneous intracranial hypotension. A host of connective tissue disorders and mechanical factors may precipitate the condition. Conservative treatment has limited efficacy, and many patients with persistent symptoms ultimately require epidural blood patch (EBP). However, about 23%-44% of patients experience recurrence of symptoms after EBP. Unidentified or multiple sites of CSF leaks are thought to be responsible for the failure of EBP. Using our previously published technique, we treated a patient who developed a large spontaneous CSF leak in her cervicothoracic spine after a boxing class, offering further evidence of the utility of the technique for select patients | ||
| 520 | |a CASE DESCRIPTION: A 28-year-old woman was referred to our center with recurrent, severe headaches and associated nausea and vomiting. She underwent EBP 3 times with no resolution of her symptoms. A right-side partial C7-T1 hemilaminotomy was performed to identify a large meningocele filled with CSF. After dissection, dural sealant was applied using an angled needle with a syringe to buttress the meningocele to allow for normalization of the hydrostatic pressure. At 5-month follow-up, her symptoms have resolved with no headaches and paresthesias in upper limbs | ||
| 520 | |a CONCLUSIONS: Commonplace events, such as a boxing/sparring class, may precipitate a spontaneous spinal CSF leak. Our minimally invasive surgical approach can be safely used in patients with spontaneous intracranial hypotension with recurrent symptoms, no identified leak site, and prior failed attempts of EBP | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Boxing | |
| 650 | 4 | |a Epidural blood patch | |
| 650 | 4 | |a Failed | |
| 650 | 4 | |a Spinal CSF leak | |
| 650 | 4 | |a Surgery | |
| 700 | 1 | |a D'Amico, Randy |e verfasserin |4 aut | |
| 700 | 1 | |a Tucker, Amy |e verfasserin |4 aut | |
| 700 | 1 | |a Abel, Mariya |e verfasserin |4 aut | |
| 700 | 1 | |a Langer, David |e verfasserin |4 aut | |
| 700 | 1 | |a Boockvar, John |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t World neurosurgery |d 2010 |g 139(2020) vom: 10. Juli, Seite 478-482 |w (DE-627)NLM197924441 |x 1878-8769 |7 nnns |
| 773 | 1 | 8 | |g volume:139 |g year:2020 |g day:10 |g month:07 |g pages:478-482 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.wneu.2020.04.194 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 139 |j 2020 |b 10 |c 07 |h 478-482 | ||