Abstract 123: Microcatheter Guided Blood Patch for Treatment of Cervical Cerebrospinal Fluid Leak

Introduction Epidural blood patch (EBP) remains the therapy of choice in treating refractory headaches due to low cerebrospinal fluid (CSF) pressure. If a CSF leakage source is detected, targeted fluoroscopy‐guided EBP should be considered over non‐targeted (blind) technique. Cervical CSF leakage can be challenging to treat with targeted EBP given the high‐risk site. Methods We present a case of microcatheter‐guided targeted cervical EBP. A 44‐year‐old male with no significant past medical history presented with 4 weeks history of refractory headaches upon sitting and standing up. MRI brain showed bilateral subdural hygromas alongside diffuse pachymeningeal enhancement. A spinal myelogram showed evidence of a CSF leak at C4‐C5 level. Results The patient was placed in prone position to access the space between the spinous processes of L2 and L3 vertebrae. A 14‐gauge 6‐inch needle was then inserted at the interlaminar space, and CSF was observed. The needle was then exchanged over a microwire with a 4F introducer sheath under fluoroscopic guidance. Once the sheath was confirmed to be in the epidural space, a 0.014‐inch microwire was introduced and advanced into the cervical region. A 0.021‐inch ID microcatheter was advanced over the wire and parked at the C5‐C6 level. Then, 10cc of autologous blood mixed with Omni opaque contrast was injected through the microcatheter into the epidural space at the C5‐C6 level. Dyna CT demonstrated blood layering in the epidural space both anteriorly and posteriorly to the Dural sac, covering the entirety of the cervical region. Patient reported an instant relief of headache during the EBP and continued to be headache‐free by the time he was discharged. Conclusion We illustrated fluoroscopy‐guided microcatheter‐assisted EBP as an effective treatment of intracranial hypotension due to cervical CSF leak.