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• W4297260014 abstract "Dear Editor, Incidental dural tear with cerebrospinal fluid (CSF) leakage may complicate lumbar spinal surgery and favour pseudomeningocele formation. Where possible, repair should be made through direct techniques including suture and tissue-glue application [1]. However, in the presence of persisting postural headaches, vertigo and meningeal symptoms despite medications, other options should be considered. Epidural blood patch is not indicated in this setting. We report the case of a patient with persisting headaches due to lumbar dural tear that were successfully treated with bilateral topical sphenopalatine ganglion block (SPGB). Written informed consent was obtained from the patient. A 47-year-old woman with a history of lumbar discectomy was admitted for a symptomatic recurrence of L3–L4 disc herniation. She underwent a lumbar arthrodesis with herniotomy (Day 1). An intraoperative dural tear persisted despite the use of fat grafts. A large, asymptomatic pseudomeningocele (12 × 7 cm) developed postoperatively (Figure 1A). Meantime, the patient had postural headaches rated 7/10 using pain numerical rating scale (NRS 0–10) despite the concomitant use of acetaminophen, nefopam, tramadol, ketoprofen, caffeine and gabapentin. A first topical SPGB was performed on Day 4 by inserting into each nostril a cotton swab soaked with 2 mL of 1% lidocaine for 5 minutes. Within the next 10 minutes, the pain rate dropped to 0 during the following 4 hours. Because of pain resurgence, a second SPGB was performed on same day using 1 mL of 5% ropivacaine for 10 minutes. The pain NRS was rated 0–2 during the following 14 hours. The patient was then able to get up and walk. She did not require tramadol anymore and she did not use others opioids for the rest of her hospital stay. The patient was discharged uneventfully from hospital on Day 12, after ensuring that there were no complications related to the pseudomeningocele. Three months later, the patient reported one weekly episode of residual headaches treated with acetaminophen, and no pseudomeningocele was found on lumbar imaging at 6 months (Figure 1B)." @default.
• W4297260014 created "2022-09-28" @default.
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• W4297260014 date "2022-09-27" @default.
• W4297260014 modified "2023-09-26" @default.
• W4297260014 title "Bilateral Sphenopalatine Ganglion Block for Postoperative Spinal Dural Tear" @default.
• W4297260014 cites W2189231349 @default.
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• W4297260014 doi "https://doi.org/10.1093/pm/pnac146" @default.
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