Article ID: 18-0030
Following a constant orthostatic headache and nausea three weeks after undergoing a urological surgery, the patient, a 16-year-old male, was referred to our hospital. An initial epidural blood patch (EBP) was performed at level L4/5 where twenty milliliters of autologous blood was administered using an 18-G epidural needle; providing no improvement. Since a spinal computed tomography (CT) revealed an insufficient blood spread to the ventral lumbar epidural space, during the second EBP, a Racz catheter was inserted from the sacral fissure and placed at level L4/5 in the ventral epidural space. This was done while simultaneously performing an additional epidural puncture at level L3/4. Twenty milliliters of blood were administered in total. This time, spinal CT demonstrated sufficient spread of blood around the epidural space followed by the patient's prompt improvement. We conclude that the Racz catheter technique can efficiently administer blood to the cerebrospinal fluid leak sites and may be useful for intractable post dural puncture headache.
