RESUMEN
A novel transosseous approach for percutaneous access of the lumbar subarachnoid space is described in a patient with advanced ankylosing spondylitis (AS) and instrumented spinal fusion who presented for myelography. Use of a coaxial threaded bone biopsy system to provide transosseous access to the thecal sac, imaging findings, and outcome are discussed. This technique provided access to an otherwise inaccessible subarachnoid space and is an alternative approach in the setting of advanced AS or posterior spinal fusion.
Asunto(s)
Vértebras Lumbares , Fusión Vertebral/métodos , Espondilitis Anquilosante/cirugía , Adulto , Humanos , MasculinoAsunto(s)
Edema Encefálico/diagnóstico , Edema Encefálico/etiología , Epilepsia Generalizada/complicaciones , Epilepsia Generalizada/diagnóstico , Angiografía por Resonancia Magnética/métodos , Enfermedades Talámicas/diagnóstico , Enfermedades Talámicas/etiología , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.
