{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:24:28Z","timestamp":1793319868630,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.<\/jats:p>\n               <jats:p>Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.<\/jats:p>\n               <jats:p>Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.<\/jats:p>","DOI":"10.1136\/bcr-2021-247598","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T11:05:25Z","timestamp":1646305525000},"page":"e247598","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cerebrospinal fluid fistula after combined spinal-epidural block"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8225-3535","authenticated-orcid":false,"given":"Ana Isabel","family":"Pereira","sequence":"first","affiliation":[{"name":"Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Lastra","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Amorim","sequence":"additional","affiliation":[{"name":"Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0143-3719","authenticated-orcid":false,"given":"Sara","family":"Nunes","sequence":"additional","affiliation":[{"name":"Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"2025082711193195000_15.3.e247598.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2000.9.1.5","article-title":"Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas","volume":"9","author":"Hawk","year":"2000","journal-title":"Neurosurg Focus"},{"key":"2025082711193195000_15.3.e247598.2","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2003.15.2.9"},{"key":"2025082711193195000_15.3.e247598.3","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1213\/01.ANE.0000100660.26058.34","article-title":"Persistent cerebrospinal fluid leak: a complication of the combined spinal-epidural technique","volume":"98","author":"Chan","year":"2004","journal-title":"Anesth Analg"},{"key":"2025082711193195000_15.3.e247598.4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jclinane.2012.11.012","article-title":"Successful management of a thoracic cerebrospinal fluid cutaneous fistula in a two year old child using a thoracic epidural blood patch","volume":"25","author":"Franklin","year":"2013","journal-title":"J Clin Anesth"},{"key":"2025082711193195000_15.3.e247598.5","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-00115550-200801000-00013"},{"key":"2025082711193195000_15.3.e247598.6","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.redar.2017.02.007","article-title":"Cerebrospinal fluid cutaneous fistula following obstetric epidural analgaesia. Case report","volume":"64","author":"Fedriani de Matos","year":"2017","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"2025082711193195000_15.3.e247598.7","first-page":"43","article-title":"[Acetazolamide in the resolution of cerebrospinal fluid cutaneous fistula after peridural analgesia: case report]","volume":"83","author":"Ju\u00e1rez-Adame","year":"2015","journal-title":"Cir Cir"},{"key":"2025082711193195000_15.3.e247598.8","doi-asserted-by":"crossref","first-page":"003","DOI":"10.17352\/2455-3476.000007","article-title":"Cerebrospinal fluid cutaneous fistula after uneventful epidural analgesia","volume":"19","author":"Thong","year":"2015","journal-title":"Global Journal of Anesthesiology"},{"key":"2025082711193195000_15.3.e247598.9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.7243\/2049-9752-3-2","article-title":"Persistent cerebrospinal fluid-cutaneous fistula after epidural analgesia: a case report and review of literature","volume":"3","author":"Tsai","year":"2014","journal-title":"J Anesthesiol Clin Sci"},{"key":"2025082711193195000_15.3.e247598.10","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1515\/sjpain-2018-0073","article-title":"Cerebrospinal fluid cutaneous fistula after neuraxial anesthesia: an effective treatment approach","volume":"18","author":"Marinho","year":"2018","journal-title":"Scand J Pain"},{"key":"2025082711193195000_15.3.e247598.11","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2044.1994.tb03426.x","article-title":"Cerebrospinal fluid cutaneous fistula. An unusual complication of epidural anaesthesia","volume":"49","author":"Howes","year":"1994","journal-title":"Anaesthesia"},{"key":"2025082711193195000_15.3.e247598.12","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1213\/XAA.0000000000000356","article-title":"Cerebrospinal Fluid-Cutaneous fistula after continuous spinal catheter in an obstetric patient","volume":"7","author":"Lenart","year":"2016","journal-title":"A A Case Rep"},{"key":"2025082711193195000_15.3.e247598.13","first-page":"112","article-title":"Persistent leak post epidural analgesia: diagnostic and therapeutic dilemma","volume":"57","author":"Bakshi SG","year":"2015","journal-title":"Bombay Hosp J"},{"key":"2025082711193195000_15.3.e247598.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeh069"},{"key":"2025082711193195000_15.3.e247598.15","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/pan.13629","article-title":"Persistent subcutaneous CSF leak after removal of epidural catheter","volume":"29","author":"Rusy","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"2025082711193195000_15.3.e247598.16","first-page":"1577","article-title":"Fluid leak from epidural puncture site: a diagnostic dilemma","volume":"99","author":"Chan","year":"2004","journal-title":"Anesth Analg"},{"key":"2025082711193195000_15.3.e247598.17","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/0970-9185.150581","article-title":"Cutaneous fluid leakage after epidural catheter removal","volume":"31","author":"Dalal","year":"2015","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025082711193195000_15.3.e247598.18","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1093\/clinchem\/39.7.1444","article-title":"Transferrin allelic variants may cause false positives in the detection of cerebrospinal fluid fistulae","volume":"39","author":"Sloman","year":"1993","journal-title":"Clin Chem"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:19:39Z","timestamp":1756318779000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,3]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/bcr-2021-247598"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247598","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3]]}}}