Epidural blood patch under fluoroscopic control: non-surgical treatment oflumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system

The treatment of lumbar cerebrospinal fluid fistula in the presence of an i ntrathecal catheter is known to be difficult. Open revision surgery is reco mmended in the literature, although the rate of recurrence is high. The epi dural blood patch technique is well established as a successful treatment f or post-dural-puncture headaches. Recent work about the distribution of the injected blood and theoretical considerations about the mechanism of actio n make this method suitable for the occlusion of spinal leakage even in the presence of an intrathecal catheter. In this note technical details are gi ven for a successful therapy of lumbar cerebrospinal fluid fistula includin g the right positioning of the opening of the needle (cerebrospinal fluid c an be expected intrathecally and epidurally) by injection of contrast mediu m first for myelography then for epidurography. In this procedure the (epid ural) distribution of autologous blood can be indirectly controlled by comp ression of the dural sac. The method is easy to perform, and the possible r isks are small.