Abstract
The patient was a 47-year-old man. Orthostatic headache, queasiness, and ear congestion caused his referral to our hospital after twice receiving subdural hematoma removal surgery. A CT myelography (CTM) showed extensive contrast agent leakage. A cerebrospinal fluid leak was diagnosed, and an interlaminar epidural blood patch (I-EBP) was performed from two sites: C7/Th1 and Th11/12. He was discharged once with symptomatic amelioration, but some symptoms persisted with significant contrast in MRI findings of the brain at reexamination. When CTM was reperformed, the contrast agent leaked. An autologous blood patch was therefore applied. A transforaminal epidural blood patch (T-EBP) was planned, considering a possible dorsal epidural adhesion. After a right T-EBP, the CTM showed autologous blood spreading into tissues surrounding the nerve root and ventral epidural space. Based on intercostal nerve contrast imaging, a left T-EBP was terminated and an I-EBP was performed from C7/Th1. At his outpatient department visit after discharge, the symptoms and findings in contrast with MRI of the brain had improved. We thus judged this patient to have achieved a remission. T-EBP is considered to be an effective therapeutic method.
