• Sait Albayram, Bashar Abuzayed, Zehra Isik Hasiloglu, Hakan Selcuk, and Mehmet Yasar Kaynar.
• Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, PO Box: 34089, Cerrahpasa Street, Koca M. Pasa, Istanbul, Turkey. salbayram@hotmail.com
• Eur Spine J. 2012 Jun 1;21 Suppl 4:S378-82.

AbstractIn this article the authors describe a novel technique for performing epidural blood patch (EBP) by percutaneous CT-guided translaminar approach in challenging cases where interlaminar approach is not possible. A 24-year-old woman with medical history of multiple spinal surgeries and instrumentations for the treatment of scoliosis, presented 3 months post-operatively with acute and severe orthostatic headaches that began 1 week after surgery. Neurological examination was normal. Brain magnetic resonance imaging (MRI) showed mild thickening and contrast enhancing in the bilateral dura. Computed tomography (CT) myelography revealed CSF leakage in the level of T3 vertebra. EBP was attempted using fluoroscopic and then CT guidance; however, despite multiple attempts, the epidural space could not be accessed through the interlaminar route due to extensive instrumentation of the spine and profound structural bony abnormalities. EBP was performed successfully via a CT-guided translaminar approach using an Ostycut trephine needle (Angiomed(®)/Bard, Karlsruhe), without complications.

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