X线引导下硬膜外自体血补丁对自发性颅内低压患者的疗效

Efficacy of epidural autologus blood patch under X-ray guidance in patients with spontaneous intracranial hypotension

于2007年11月至2008年5月本院治疗自发性颅内低压患者6例，男女各3例，年龄33—66岁，病程6～35d。根据脊髓造影CT薄层扫描结果，对于单发脑脊液漏患者，选择脑脊液漏点所在脊髓节段以下1～2个椎体间隙为穿刺点，对于多发脑脊液漏患者，选择脑脊液漏较严重的节段，在C形臂X射线引导下硬膜外注射自体血与欧门派克（300g／100ml）的混合液（容量比为3：1），使混合液覆盖脑脊液漏点所在节段。记录注射自体血过程中及注射自体血后不良反应的发生情况。治疗无效者于治疗后1周行下一次治疗。1例患者接受3次治疗；其余5例患者接受1次治疗。注射自体血过程中发生穿刺部位疼痛5例、上肢放射性疼痛2例、右腿麻木感2例，均自行缓解。注射自体血后未见不良反应发生，全部痊愈，随访2．6月未见复发。

Six patients （3 male, 3 female） aged 33-66 yr, course of disease 6-35 days, diagnosed with spontaneous intracranial hypotension in Sir Run Run Shaw Hospital from November 2007 to May 2008, were treated with an epidural autologus blood patch under X-ray guidance. According to the results of CT myelography, the puncture site was chosen in the 1-2 vertebral interspaces below the site of a single cerebrospinal fluid leak. For patients with multiple cerebrospinal fluid leaks, the procedure was performed at the spinal cord segment of the most severe leak. The mixture of autologous blood and Omnipaque （300 g/100 ml） at a ratio of 2：1 was injected into the epidm＇al space to cover the spinal cord segment of the leaks under C-arm fluoroscopic guidance. Side effects were recorded during and after the injection of autologus blood. The treatment was repeated one week later if the former one failed. One patient was treated with epidural blood patch 3 times, and the rest 5 patients were treated with epidural blood patch 1 time. During the injection of autologus blood, 5 patients complained of pain in the puncture site, 2 experienced pain radiating to the upper limb, 2 felt numbness in the right leg, and all of these syndromes could be self-relieved. No side effects were observed after the injection of autologus blood. All the patients were cured and no recurrence was observed during a 2-6 month follow-up.