• Tatsuya Ohtonari, Shinzo Ota, Takahiro Himeno, Nobuharu Nishihara, Michiyoshi Sato, and Akio Tanaka.
• Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan. Electronic address: ohtonari@shouwa.or.jp.
• World Neurosurg. 2018 Oct 1; 118: e276-e282.

ObjectiveThe effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period.MethodsNineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively.ResultsDifferent types of headache were observed, including typical orthostatic headache alone (n = 10), orthostatic headache with chronic subdural hematoma (CSDH) (n = 3), and posture-unrelated headache accompanied with CSDH (n = 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases.ConclusionsWe demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.Copyright © 2018 Elsevier Inc. All rights reserved.

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