انجام پچ خون در فضای اپیدورال از طریق فضای کودال در بیمار با نشت مایع مغزی‌نخاعی: گزارش یک مورد

زمینه و هدف: نشت مایع مغزی‌نخاعی (cerebro-spinal fluid, csf) به‌علت آسیب لایه دورامتر، به‌دنبال جراحی ستون فقرات از عوارض نادر این جراحی می‌باشد. یکی از روش‌های کنترل علایم آن در صورت شکست درمان‌های حمایتی تزریق خون بیمار به فضای اپیدورال (ebp) در سطوح مجاور محل نشت می‌باشد.معرفی بیمار: بیمار خانم 56 ساله می‌باشد، که اردیبهشت 1402 به‌دنبال جراحی لامینکتومی مهره چهارم به‌علت هرنی دیسک بین مهره‌ای و تنگی فورامن کمری l4-l5، دچار لیک مایع مغزی‌نخاعی شده است. با‌توجه به وجود برش جراحی در محل لیک و عدم‌دسترسی به فضای اپیدورال از آن محل و علایم آزار دهنده در بیمار به همین دلیل از طریق فضای اپیدورال کودال و ارسال کاتتر به فضای l5، 17 سی‌سی خون به فضای مورد‌نظر تزریق شد.نتیجه‌گیری: در موارد عدم‌امکان دسترسی به فضای اپیدورال با رویکرد اینترلامینار می‌توان از طریق فضای کودال با قرار دادن کاتتر اقدام به ebp نمود.

performing epidural blood patch through the caudal space in a patient with cerebrospinal fluid leakage: a case report

background: csf fluid leakage due to damage to the dura mater layer is a rare complication of spine surgery. one of the methods to control symptoms in case of failure of supportive treatments is to inject the patient’s blood into the epidural space at the levels adjacent to the leakage sitecase presentation: the patient is a 56-year-old woman, who suffered a csf leak after laminectomy of the fourth vertebra. due to the presence of a surgical incision at the leak site, the lack of access to the epidural space from that location, and disturbing symptoms, caudal space was chosen. method, in a prone position with vital signs monitoring, proper sedation, and local anesthetic injection, in completely sterile conditions, with the help of fluoroscopy, through the sacral hiatus  tuohy 18g needle entered into the epidural space and contrast material was injected, the exact location of the needle in the ap-lateral view ensured, the epidural catheter was measured from the skin to the approximate location of the l4 vertebra and about 20 cm of the catheter was shortened to facilitate blood injection then the catheter was inserted into the epidural space again, the contrast material was injected into the catheter and the diffusion of the contrast material was seen at the level of the fifth vertebra. then, in the cubital vein, a 16g iv cannula was inserted under completely sterile conditions. then 20 cc of blood was taken from the patient’s peripheral vein and slowly injected into the catheter. after the injection of 17 cc, the patient felt heaviness and pain in the lower back, the blood injection was stopped and the catheter and needle were removed. the needle insertion site was bandaged and the patient with stable vital signs and full consciousness was transferred to the recovery room and then to the ward. conclusion: when it is not possible to access the epidural space via the interlaminar approach, the caudal space by inserting a catheter can be a good alternative.