What Is a Post-Dural-Puncture Headache?

The epidural space is located in the narrow space between the spinal periosteal membrane and the spinal dura mater. It is filled with fat, intravertebral venous plexus, and lymphatic vessels, and has spinal nerve roots and associated blood vessels passing through it. The upper end of this cavity rises from the height of the occipital foramen, and the lower end is finally a sacral canal hole. Because the dura mater is attached to the edge of the occipital foramen, this cavity does not pass through the skull.

Dura mater

Clinical epidural anesthesia is the injection of drugs into this cavity to block the spinal nerve root. After the puncture needle is inserted into the cavity, there is a sense of evacuation due to negative pressure, which is different from the case where there is cerebrospinal fluid flowing out and showing positive pressure when penetrating into the subarachnoid space. The epidural space is divided into anterior and posterior cavities by the spinal nerve root. The anterior cavity is narrow and the posterior cavity is large, with fat, venous plexus, and spinal nerve roots. On the midline, the anterior cavity has loose connective tissue connected to the dura mater and the posterior longitudinal ligament, and the posterior cavity has a fibrous septum connected behind the vertebral arch and the dura mater. These structures have a high incidence of cervical and upper thoracic segments and are denser. They are anatomical factors that lead to unilateral or incomplete anesthesia in epidural anesthesia. The epidural space of the sacral segment is large and small, wide anteriorly and narrowly, and the dura mater is close to the posterior wall of the spinal canal with a spacing of 0. l 0.15cm, pay attention to the angle of the puncture needle when anesthesia is performed. The dural sac flattened from the 2nd sacral vertebra. It was tapered and wrapped with terminal filaments. The anterior and posterior fibers were connected to the anterior and posterior walls of the sacral canal. Full of fat, which may be unilateral

Epidural angiography is a method of injecting a contrast agent into the epidural space to show changes in the periphery of the dura. Because the epidural space is filled with contrast agent, after the development of the intervertebral disc, the filling defects of the intervertebral space and the extent of the occupying lesions in the arachnoid lumen can be seen. Because the contrast agent is outside the dura mater, it will not affect the arachnoid membrane, and there is no sequelae such as arachnoiditis after imaging. It is a safer imaging method.

Connective tissue epidural angiography