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PEDIATRIC ANESTHESIA

Lumbar Epidural Blood Patch to Treat a Large, Symptomatic Postsurgical Cerebrospinal Fluid Leak of 5 Weeks Duration in a 3-Year-Old

From the Department of Pediatric Anesthesiology, University of New Mexico, Albuquerque, New Mexico

Address correspondence and reprint requests to Dr. John C. Sanders, Department of Anesthesiology and Critical Care, University of New Mexico, Surge Building, 2701 Frontier NE, Albuquerque, NM 87131. Address email to jcsanders{at}salud.unm.edu

A 3-yr-old with B-cell lymphoma presented with a 5-wk history of 400 mL/day cerebrospinal fluid (CSF) leak, which precluded chemotherapy, after placement of an Omaya reservoir and drain. Surgical repair was unsuccessful. Symptoms included irritability, failure to eat and noncommunication. After lumbar epidural blood patch with 7 mL the symptoms resolved immediately, allowing recommencement of chemotherapy. Epidural blood patch should be considered as possible early treatment for CSF leaks.

IMPLICATIONS: An epidural blood patch successfully treated a large cerebrospinal fluid leak of long duration in a 3-yr-old. Considering the distress of such a leak to the patient, staff, and parents, epidural blood patch may be considered as an early treatment option.