• Keisuke Takai and Makoto Taniguchi.
• Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. Electronic address: takai-nsu@umin.ac.jp.
• World Neurosurg. 2017 Nov 1; 107: 351-357.

ObjectiveTargeted epidural blood patch (EBP) at the site of a presumed cerebrospinal fluid leak reportedly has better outcomes than non-targeted EBP; however, it is associated with a higher risk of wrong-site injection, such as iatrogenic subarachnoid or intramuscular injections, which lead to reintervention because of the insufficient coverage of injected blood.MethodsEight patients with intracranial hypotension owing to a CSF leak diagnosed with myelographic computed tomography (CT) and thin-cut magnetic resonance imaging (MRI) received an epidural blood patch under O-arm-guided stereotactic navigation.ResultsThe leak site was identified on the basis of myelographic CT findings of a micro-spur, epidural contrast medium extravasations, and MRI findings of a ventral dural defect. During the EBP procedure, no iatrogenic dural puncture or subarachnoid injection occurred because O-arm-guided stereotactic navigation provided real-time feedback on the needle trajectory. O-arm CT revealed the sufficient coverage of injected blood following the first injection in 6 of 8 patients. In the 2 remaining patients, a second injection was performed during the same session because of insufficient coverage at the previous site. In all patients, complete recovery from orthostatic headaches was achieved after a single session.ConclusionsO-arm-guided navigation facilitated EBP by enabling real-time observations of the needle trajectory and distribution of injected blood while simultaneously avoiding major complications, such as wrong-site injections or reintervention.Copyright © 2017 Elsevier Inc. All rights reserved.

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