Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience

Table 1

Summary of results.

Patient	Age	Gender	Indication	Conservative treatments	Catheter level	EBP level	Image guidance?	Volume (mL)	POD#	Skin prep	Complications
1	54	M	Multiple sclerosis	1, 2, 3, 5	L1-2	L2-3	Yes	20	4	ChloraPrep	None
2	49	F	Ovarian cancer	1, 2, 3, 4, 5	L4-5	L5-S1	Yes	20	5	ChloraPrep	None
3	57	M	Multiple sclerosis	1	L2-3	L3-4	Yes	20	36	ChloraPrep	None
4	49	F	Spasticity; spinal cord injury	1, 2, 3, 4, 5, 6	L3-4	L4-5	Yes	12	13	ChloraPrep	None
5	54	M	Prostate cancer	1, 2, 3	T10-11	T10-11	Yes	15	16	Bacitracin	None
6	45	F	Multiple sclerosis	1	L2-3	L4-5	Yes	20	3	ChloraPrep	None
7	72	M	Lung cancer	1, 2	L1-2	L3-4; L5-S1	Yes	15; 20	20; 28	ChloraPrep	None
8	45	F	Breast cancer	1, 3, 5	L2-3	L4-5	Yes	20	8	ChloraPrep; Betadine	None
9	43	M	Spasticity; spinal cord injury	1, 2, 3	L2-3	L4-5	Yes	20	7	ChloraPrep	None
10	49	M	Pancreatic cancer	1, 2, 3, 4	L3-4	L5-S1	Yes	20	3	ChloraPrep	None
11	30	M	Spasticity; spinal cord injury	1, 2, 3, 4, 5	L3-4	L4-5; L4-5	Yes	20; 22	12; 15	Betadine	None
12	34	F	Melanoma	1	L2-3	L3-4	Yes	18	14	Unknown	None
13	50	F	Pancreatic cancer	1, 2, 3, 5	L1-2	L5-S1	Yes	15	7	ChloraPrep	None
14	43	F	Multiple sclerosis	1, 2, 3, 5	L2-3	L3-4	Yes	20	6	Betadine	None
15	53	F	Multiple sclerosis	1	L3-4	L5-S1	Yes	Unknown	7	Unknown	None

Key: conservative treatments:
() Bedrest.
() IV fluids.
() Caffeine.
() Antiemetics.
() Acetaminophen.
() Opioids.
Patient found to have persistent CSF leak despite initial blood patching. Ultimately required reopening of the incision and placement of a purse-string stitch and/or fibrin glue along the catheter insertion site.
Transient relief after initial blood patch. Blood patch was repeated and symptoms resolved.