CT-guided percutaneous intraspinal needle aspiration for the diagnosis and treatment of epidural collections Poster No.: P-0064 Congress: ESSR 2013 Type: Scientific Exhibit Authors: G. Petrocheilou, I. Vlachou, S. Stathopoulou, C. Kokkinis ; 1 1 1 2 2 2 Athens/GR, Papagou, Athens/GR Keywords: Abscess, Drainage, CT, Musculoskeletal spine DOI: 10.1594/essr2013/P-0064 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.essr.org Page 1 of 9
Purpose To describe CT-guided percutaneous drainage of epidural abscesses-hematomas as a contribution in patients' management. Methods and Materials CT-guided percutaneous intraspinal needle aspiration was performed in seven (6) patients, after MRI examination of the spine. There were four (4) cases with posterior epidural abscesses in the thoracic or lumbar spine and two (2) with posterior epidural hematomas in the lumbar spine. All patients had minimal to mild neurologic deficit. Results In the four cases with epidural abscesses, CT-guided aspiration showed purulent material confirming diagnosis and the culture specimen determined the causative agent. A partial decompression was obtained in all cases. In two cases the spinal epidural abscess completely resolved after 4 weeks of antibiotic therapy. In the other two cases with neurologic deficit progression a surgical decompression was decided. In the two cases with epidural hematomas, a moderate drainage was performed but surgical evacuation was avoided as the patients remained neurologically stable and they were poor surgical candidates. The hematomas resolved after 6 weeks. Images for this section: Page 2 of 9
Fig. 1: CT of epidural hematoma. Page 3 of 9
Fig. 2: Saggital MPR of epidural hematoma (TH 12). Page 4 of 9
Fig. 3: CT-guided aspiration of epidural hematoma. Page 5 of 9
Fig. 4: CT-guided aspiration of epidural hematoma. Page 6 of 9
Conclusion CT-guided percutaneous intraspinal needle aspiration is a safe and successful technique for diagnosis and in some cases it may provide a therapeutic alternative to surgery of epidural collections. Images for this section: Fig. 5: CT of epidural abcess (L5-S1). Page 7 of 9
Fig. 6: CT-guided aspiration of epidural abcess (L5-S1). Page 8 of 9
References 1. 2. 3. 4. 5. Boström A, Oertel M, Ryang Y, Rohde V, Bürgel U, Krings T, Korinth M, Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess--a review of 46 cases. Minim Invasive Neurosurg. 2008 Feb;51(1):36-42. Rust TM, Kohan S, Steel T, Lonergan R, CT guided aspiration of a cervical spinal epidural abscess.j Clin Neurosci. 2005 May;12(4):453-456. Lyu RK, Chen CJ, Tang LM, Chen ST. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery. 2002 Aug;51(2):509-12; discussion 512. Kebaish KM, Awad JN, Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurg Focus. 2004 Jun 15;16(6). Teo HE, Peh WC, Tan SB,Percutaneous drainage of a postoperative intraspinal hematoma using a Tuohy needle. Skeletal Radiol. 2003 Oct;32(10):603-7. Epub 2003 Jul 24. Personal Information Page 9 of 9