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The subdural space: the third place to go astray.

Subdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example, 'unexplained' headache, false-negative aspiration test down needle or catheter, false-negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.

Adult↗

[Intraoperative irrigation of the subdural space after traumatic spinal cord lesions (based on 4 case examples)].

In experimental investigations on primates it has been shown that after a standardized transverse lesion of the spinal cord subdural perfusion with an artificial liquor solution (Elliot's B solution) of the region of the injury improved the eventual motoric function achieved. We tried to reproduce these experimental results in the management of four patients with acute spinal cord injury after trauma of the vertebral column. Due to the difficulty of an exact evaluation in this initial study an objective positive effect of perfusion with Ringer solution (at 37 degrees C) could not be confirmed in these patients. Nevertheless, the possibility of a positive influence of this adjuvant operative treatment on spinal cord injuries should be studied in a greater collective of patients. A multicentre study would be essential because of the limited number of cases in a single hospital.

Adult↗