- •Initial two-site blind EBP and targeted EBP for SIH showed similar outcomes.
- •Targeted EBP requires an additional CT myelography procedure with potential risk.
- •Two-site blind EBP can be an alternative initial treatment for SIH.
Spontaneous intracranial hypotension (SIH), caused by CSF leaks, can trigger headaches, and is treated using epidural blood patch (EBP) procedures. We aimed to determine the effectiveness of a newly devised two-site blind EBP procedure as the initial treatment for SIH and compare its effectiveness with that of conventional targeted EBP.
We retrospectively reviewed data for 116 patients who underwent EBP for SIH between November 2013 and April 2017. Patients were divided into two groups: those who initially received two-site blind EBP (n = 28) at the cervicothoracic (C7/T1) and thoracolumbar junctions (T12/L1) for sealing CSF leaks at all levels, and those who received targeted EBP after CT myelography (n = 88). The initial recovery status and the need for additional blood patches were evaluated.
In total, 71.4% and 69.3% patients in the two-site blind EBP and targeted EBP groups, respectively, experienced complete relief after the first patch (p > .05); collectively, 89.3% and 96.6% patients, respectively, experienced complete or partial relief after the first patch (p > .05). A second EBP was required by 35.7% and 29.5% patients in the two-site blind EBP and targeted EBP groups, respectively, with no significant between-group difference (p > .05). All patients ultimately experienced relief; a few required up to four patches.
We observed similar outcomes after initial two-site blind EBP and targeted EBP. Therefore, two-site blind EBP is an effective alternative to conventional targeted EBP and a potential initial patch of choice for SIH treatment.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.J Neurosurg. 1996; 84: 598-605
- Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.JAMA. 2006; 295: 2286-2296
- Spontaneous cerebrospinal fluid leak syndrome: report of 18 cases.Neurol. Sci. 2004; 25: 293-295
- Early epidural blood patch in spontaneous intracranial hypotension.Neurology. 2004; 63: 1950-1951
- Epidural blood patch illustrated by CT-epidurography.Acta Anaesthesiol Scand. 1995; 39: 613-617
- Spontaneous intracranial hypotension Efficacy of radiologic targeting vs blind blood patch.Neurology. 2011; 76: 1139-1144
- Clinical features, neuroimaging and treatment of spontaneous intracranial hypotension and magnetic resonance imaging evidence of blind epidural blood patch.Eur Neurol. 2009; 61: 301-307
- Spontaneous intracranial hypotension: targeted or blind blood patch.J Clin Neurosci. 2016; 25: 10-12
- Is it a rational choice to treat with lumbar epidural blood patch headache caused by spontaneous cervical CSF leak?.Cephalalgia. 2006; 26: 1245-1246
- Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension.Eur J Neurol. 2010; 17: 715-719
- Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension: case report and review of the literature.World Neurosurg. 2017; 97: 27-38
Headache Classification Committee of the International Headache Society (IHS), The International Classification of Headache Disorders, 3rd edition (beta version), Cephalalgia 33 (2013), pp. 629–808.
- The usefulness of MDCT-myelography for patients with spontaneous intracranial hypotension.Springerplus. 2016; 5: 424
- Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension.Neuroradiology. 2012; 54: 1367-1373
- Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment.J Neurosurg. 2010; 113: 940-946
- The efficacy of epidural blood patch in spontaneous CSF leaks.Neurology. 2001; 57: 1921-1923
- Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.Turk Neurosurg. 2015; 25: 320-325
- Cervical epidural blood patch for low CSF pressure headaches.Neurology. 2005; 65: 1138
- Spontaneous spinal cerebrospinal fluid leaks: a review.Neurosurg Focus. 2000; 9: 1-9
- Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks.Headache. 2013; 53: 1034-1053
Published online: November 26, 2018
Accepted: November 11, 2018
Received: September 29, 2018
© 2018 Elsevier Ltd. All rights reserved.