Topical Transnasal Sphenopalatine Ganglion Block as Management for Postdural Puncture Headache. Where Does It Fit? A Case Report and Literature Review

De Cesaro MP*, Cherubini GRL, Menck JT, da Silva Cunha DR, Negri MG, Koga RB, Scherer EC, Okuma EP, Spagnuolo Moreira FMD, Barreto da Serra e Silva TL and de Oliveira RM

Department of Anesthesiology, Hospital Nossa Senhora das Graças, Brazil

^*Correspondance to: De Cesaro MP 

 PDF  Full Text DOI: 10.25107/2474-1647.3590

Abstract

Debilitating and sometimes life-threatening, Postdural Puncture Headache (PDPH) remains simple to recognize but challenging to treat and understand its physiopathology and consequences. With the aim of better understand the potential contribution of topical transnasal Sphenopalatine Ganglion Block (SPGB) in Central Venous Thrombosis (CVT) as a treatment of PDPH, we reviewed the literature and describe a case of CVT after PDPH managed with SPGB. A 68-year-old male patient, American Society of Anesthesiologists physical status 2 underwent an uneventful Transurethral Resection of the Prostate (TURP) under sedation and spinal anesthesia. Neither personal, nor familiar risk factor for thrombosis was referred. On the fourth postoperative day, the patient was treated with SPGB due to PDPH. Following six days, referring diplopia, he was diagnosed with CVT evidenced by Magnetic Resonance Angiography (MRA). After twenty-two days of anticoagulation and complete resolution of his symptoms, the patient continues been monitoring by neurology with no recurrence so far. Compared with Epidural Blood Patch (EBP) for treatment of PDPH, SPGB showed faster headache relief, lesser expensive, safer and better tolerated without associated complications besides a proposed causal relationship between SPGB and CVT. Well conducted trials should be developed in order to stablish where SPGB fits: protector or risk factor, or only the trigger to manifest clinical signs of a thrombus already inside of cerebral veins.

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Cite the article

De Cesaro MP*, Cherubini GRL, Menck JT, da Silva Cunha DR, Negri MG, Koga RB, et al. Topical Transnasal Sphenopalatine Ganglion Block as Management for Postdural Puncture Headache. Where Does It Fit? A Case Report and Literature Review. Clin Surg. 2022; 7: 3590..