Targeted epidural patch with n-butyl cyanoacrylate (n-BCA) through a single catheter access site for treatment of a cerebral spinal fluid leak causing spontaneous intracranial hypotension

BMJ Case Rep. 2015 Jun 2:2015:bcr2015011778. doi: 10.1136/bcr-2015-011778.

Abstract

Spontaneous intracranial hypotension (SIH) usually occurs in the setting of a spontaneous cerebral spinal fluid (CSF) leak. We report the first description of a case of SIH caused by a CSF leak which improved after a targeted epidural patch with n-butyl cyanoacrylate (n-BCA) at the right T1-T2 level. An 81-year-old woman presented with an orthostatic headache for 6 days. MRI of the brain with contrast demonstrated low lying cerebellar tonsils, an engorged transverse sinus flow void, bifrontal small subdural fluid collections, and diffuse dural enhancement. CT myelography showed extravasation of intrathecal contrast at the right T1-T2 level. A targeted epidural patch was performed by injection of n-BCA through a catheter at the right T1-T2 level. After treatment, the patient's symptoms immediately improved and she was without a headache at 1-year follow-up.

Keywords: Catheter; Epidural; Liquid Embolic Material; Spine.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Blood Patch, Epidural / methods*
  • Cerebrospinal Fluid Leak / complications
  • Cerebrospinal Fluid Leak / therapy*
  • Enbucrilate / administration & dosage*
  • Epidural Space
  • Female
  • Headache / etiology*
  • Humans
  • Intracranial Hypotension / complications
  • Intracranial Hypotension / therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Enbucrilate