Ventral Spontaneous Durotomy Following Vaginal Delivery.

Ventral Spontaneous Durotomy Following Vaginal Delivery.

World Neurosurg. 2017 Feb 09;:

Authors: Agarwal N, Kashkoush AI, Prabhu AV, Sekula RF

Abstract
INTRODUCTION: Dural breaches have a diverse etiology, including spontaneous rupture and trauma. Most cases resolve with bedrest, though in refractory cases an epidural blood patch can be placed to obstruct further leakage. Here, we discuss a unique case of a spontaneous ventral durotomy following vaginal delivery managed with injections of autologous blood through bilateral transforaminal needles.
CLINICAL PRESENTATION: A previously healthy 36-year-old pregnant female presented to the inpatient maternity ward with positional occipital headaches and neck pain 24 hours following normal spontaneous vaginal delivery. Two dorsally placed epidural blood patches provided only transient relief. Ultimately, computed tomography (CT) myelogram reveal ventral cerebrospinal fluid leak. CT-guided blood patch placement ventrally was utilized to provide targeted therapy.
CONCLUSION: Spontaneous durotomy is a rare phenomenon and should be considered in patients that present with positional headaches. Ventrally targeted therapy via epidural blood patch should be considered to provide optimal relief.

PMID: 28192271 [PubMed - as supplied by publisher]

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