頭蓋内圧低下症を来した胸椎術後髄液漏に対しepidural blood patchが奏効した1例

Epidural Blood Patch for the Treatment of Intracranial Hypotension due to Cerebrospinal Fluid Leakage after Thoracic Spine Surgery

I．はじめに

　脊髄手術後の髄液漏の合併に対しては，これまで直達手術による硬膜の修復または髄腔内の持続ドレナージが推奨されてきた^5,8,17）．今回，われわれは脊椎手術後に胸腔内への髄液漏を生じ，続発性頭蓋内圧低下症を呈した1例に対しepiduralblood patchを施行し，髄液漏の消失および症状の著明な改善をみたので報告する．

We report a case of a 44-year-old woman successfully treated by an epidural blood patch for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the thoracic cavity after thoracic spine surgery.

The patient was admitted to our hospital with the complaint of postural headaches. She had received anterior thoracic instrumentation for thoracic disc herniation four months earlier. Lumbar puncture demon-strated low CSF pressure, and Gd-enhanced MR images displayed diffuse dural enhancement. Accordingly, she was diagnosed as having intracranial hypotension. In-DTPA cisternography revealed a CSF leakage into the left thoracic cavity, possibly caused by dural laceration during thoracic spine surgery. To avoid the risk of direct surgery, we performed epidural blood patch ; 3 ml of autologus blood was in-jected into the epidural cavity. Postoperatively postural headaches immediately disappeared. MRI taken one year later revealed disappearance of diffuse dural enhancement, and "In-DTPA cisternography re-vealed no CSF fluid leaks. Epidural blood patch seems to be a choice of treatment for CSF leak after spin-al surgery.