자발성 두개내 저압 환자와 경막천자 후 두통 환자군에서의 경막외 혈액 봉합술의 효과의 비교 및 고찰 = Comparison of the Efficacy of Epidural Autologous Blood Patch in the Treatment of Spontaneous Intracranial Hypotension and Post-Dural Puncture Headache

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH).
Materials and Methods: Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19–58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher’s exact test (considered as significant when p < 0.05).
Results: In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief.
Conclusion: Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

국문 초록 (Abstract)

목적: 경막천자 후 두통과 자발성 두개내 저압 환자에서 투시장치(fluoroscopy) 유도하 경막외 혈액 봉합술의 치료 효과를 평가하고 비교하였다.
대상과 방법: 2012년 8월부터 2013년 9월까지 본원 영상의학과에서 경막외 혈액 봉합술이 시행된 환자 16명[남자 5명, 여자 11명, 평균연령 32.8세(19~58세)]의 의무기록을 후향적으로 분석하였다. 치료 후 3일째의 통증 정도를 완전 경감(complete relief), 불완전 경감(incomplete relief), 치료 실패(failure)로 나누어 평가하였다. 두통의 경감이 있으나, 다시 악화된 경우 재발(recurrence)로 정의하였다. 각 환자군의 치료효과를 Fisher’s exact test로 비교하였다.
결과: 경막천자 후 두통 환자 12명 중 5명에서(41.7%) 완전 경감을, 7명에서(58.3%) 불완전 경감을 보였고 자발성 두개내 저압 환자 4명 중 1명에서(25%) 완전 경감을, 3명에서(75%) 불완전 경감을 보였다. 두 군 사이의 치료효과는 통계적으로 유의하게 다르지 않았다(p = 0.511). 불완전 경감 환자들 중 경막천자 후 두통 환자 5명(41.7%), 자발성 두개내 저압 환자 1명에서(25%) 재발하였고 경막천자 후 두통 환자 5명에서 경막외 혈액봉합술을 재시행하여 최종적으로 불완전 경감 상태로 퇴원 가능하였다.
결론: 경막천자 후 두통 환자와 자발성 두개내 저압 환자 모두에서 투시장치 유도하 경막외 혈액 봉합술을 통해 체위성 두통의 치료를 효과적으로 할 수 있다.

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