• Adnan I Qureshi, Mushtaq H Qureshi, Ahmed A Malik, Vikram Jadhav, and Stanley H Kim.
• Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, United States.
• J Neurol Surg A Cent Eur Neurosurg. 2015 Sep 1; 76 (5): 369-75.

BackgroundApproaching and aspirating cervical and high thoracic epidural abscesses through a trans-epidural route from the lumbar region access represents an alternative method for selected patients.ObjectiveWe determined the feasibility of catheter-based manipulation and aspiration using the trans-epidural route.Material And MethodsA custom designed infusion-suction catheter system that includes an outer suction catheter and inner infusion catheter in concentric relation with radio-opaque marker bands was tested in a cadaveric preparation to determine (1) the ability to place an aspiration catheter over a guidewire using a percutaneous approach within the posterior lumbar epidural space; (2) the highest vertebral level a catheter can be advanced within the epidural space; and (3) the ability to aspirate artificial purulent-like material placed in the cervical and thoracic level epidural space.ResultsWe were able to advance two infusion-suction catheter systems from a 14G Touhy spinal needle inserted via an oblique parasagittal approach at the L2-L3 intervertebral space. The infusion-suction catheter was advanced up to the level of the cervical vertebral level of C2 within the epidural space under fluoroscopic guidance. We were able to aspirate artificial purulent-like material directly injected with a 22G Quincke spinal needle at vertebral levels C4-C5 and at vertebral levels T10-T11 by aspiration and manipulation of the outer catheter within the epidural space at levels C3-C7 and T9-L1, respectively.ConclusionsOur observations support the further exploration of a percutaneous catheter-based trans-epidural approach to treat epidural abscesses. The trans-epidural approach may be used alone or as a staged or concurrent approach with open surgical treatment.Georg Thieme Verlag KG Stuttgart · New York.

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