靶向硬膜外血贴治疗自发性颅内低压价值探讨

Targeted epidural blood patch： an effective treatment for spontaneous intracranial hypotension

目的报告脊髓脑脊液漏点精确定位后靶向硬膜外血贴治疗自发性颅内低压的经验，并对靶向硬膜外血贴的治疗机制和价值等进行讨论。方法6例自发性颅内低压患者（男女各3例，年龄33—66岁），符合2004年国际头痛分类第2版诊断标准。CT脊髓造影6例均发现脊髓脑脊液漏点。根据CT脊髓造影发现的脑脊液漏点位置选择穿刺部位，透视下注射混合碘造影剂的自体静脉血。结果6例患者经靶向硬膜外血贴治疗后获得临床痊愈。2例注射过程中出现局部神经根刺激症状，3例治疗后出现暂时眭背痛和腰痛。术后观察3至9个月均无复发。结论CT脊髓造影漏点精确定位后，靶向硬膜外血贴疗法是一种安全、有效的自发性颅内低压治疗手段。

Objective To report the authors＇ own experience in the treatment of spontaneous intracranial hypotension （SIH） with targeted epidural blood patch after locating the CSF leaks with CT myelography （CTM） and to discuss the mechanism and value of this method. Methods Six patients with SIH （3 males and 3 females aged 33-66 years） were included. All patients met the diagnostic criteria of 2nd edition of International Classification of Headache Disorders （2004）. CT myelography revealed the CSF leak sites in all 6 patients. Autologous blood mixed with Omnipaque （300 mg/ml） was injected after selective puncture at the leak site indicated by CTM. Results All patients responded well to the treatment and achieved a complete resolution of symptoms. Nerve root irritation occurred in 2 patients. Three patients suffered from a temporary back pain. Conclusion With the location of leak sites by CTM, targeted epidural blood patch is an effective way to treat spontaneous intracranial hypotension.