CHRONIC CSF LEAK INTO THE PERITONEAL-CAVITY SHOWN BY RADIONUCLIDE CISTERNOGRAPHY - SUCCESSFUL TREATMENT WITH AN EPIDURAL BLOOD PATCH

Cerebrospinal fluid (CSF) leak is a well-documented complication of a spinal puncture that is performed for both diagnostic and therapeutic purposes, The use of radionuclide cisternography in the diagnosis of c erebrospinal fluid leaks is well established and has been reported as effective in securing the diagnosis of CSF fluid leak after lumbar pun cture. The use of an epidural blood patch is effective in repairing 96 -98% of such leaks and is thought to work by both forming a dural plug and by reducing the volume of the subarachnoid space. The authors rep ort a 7-year-old boy who had recurrent medulloblastoma and developed a CSF leak into the peritoneal cavity after a course of intrathecal 4-h ydroxy-cyclophosphamide. An initial Tc-99m human serum albumin CSF flo w study before therapy was normal. A further course of intrathecal the rapy was planned; however, delayed images on a repeat CSF flow study s howed tracer activity throughout the abdomen intraperitoneally, indica ting a leak of CSF from the thecal sac presumed to be at the sight of the recent spinal puncture. A CT myelographic study showed maximal epi dural contrast at the L4-5 level, which extended from L4 through the S 1 level. After 5 months of continual leak, an epidural blood patch was performed using autologous blood. A repeat CSF flow study performed 2 weeks after this procedure showed resolution of the CSF leak.