Targeted fluoroscopic guided epidural blood patch using a Racz catheter for spontaneous intracranial hypotension

Epidural Blood Patch Using a Racz Catheter for Spontaneous Intracranial Hypotension With Unclear Leak Points

Using a Racz catheter (Brevi-XL™, Epimed Inc., NY, USA) to insert an epidural blood patch (EBP) may be an effective method of reaching the target epidural space in the cervical region. We would like to present a case, wherein a targeted EBP via Racz catheter was used in the management of spontaneous intracranial hypotension. When the leak point is clear via imaging, EBP should be performed exactly at that point. However, if the leak point is unclear, with only a contrast agent pool detected via imaging, EBP should be performed to mask the entire region of the pool. In both cases, EBP via Racz catheter is a convenient and effective method for the management of spontaneous intracranial hypotension. Further cases may be needed to verify our results.

Total Spinal Epidural "Blood Patch" Application Through a Racz Catheter in Spontaneous Intracranial Hypotension

BACKGROUND

Epidural "blood patch" (EBP) is a standard treatment of spontaneous intracranial hypotension (SIH). In recent years, there are some reports of Racz catheter use for EBP performance at upper cervical spine levels. However, the practical use of Racz catheter for single-entry multisite EBP has never been reported until now.

CASE DESCRIPTION

We treated a 60-year-old man diagnosed with SIH presenting with cerebrospinal fluid leaks from the cervical to the sacral segments. We discuss the advantages of the single-entry multisite EBP and the convenience of Racz catheter use in such cases.

CONCLUSIONS

The Racz catheter can be a convenient means to deliver large-volume EBPs from a single entry point in the treatment of SIH.