A systematic review and meta-analysis of factors affecting the outcome of the epidural blood patching in spontaneous intracranial hypotension

Recent update on epidural blood patch

“…SIH is actually a misnomer, as the majority of patients with the condition have opening CSF pressures within the normal range. SIH results from non-iatrogenic CSF hypovolemia due to CSF leakage from the spinal canal, rather than CSF hypotension [23][24][25][26]. The incidence has been estimated to be around 5/100,000 per year, peaking around the fourth or fifth decade of life and being slightly more common in women (female to male ratio, 3:2) [11,23,[25][26][27][28][29][30].…”

“…SIH results from non-iatrogenic CSF hypovolemia due to CSF leakage from the spinal canal, rather than CSF hypotension [23][24][25][26]. The incidence has been estimated to be around 5/100,000 per year, peaking around the fourth or fifth decade of life and being slightly more common in women (female to male ratio, 3:2) [11,23,[25][26][27][28][29][30]. However, mis-and under-diagnosis of the condition are common, and its actual incidence would be considerably greater [26,27,29].…”

“…mark of SIH. The meningeal enhancement involves the pachymeninges but spares the leptomeninges [9,10,23]. Approximately 10% of patients with SIH have normal brain imaging [24][25][26].…”

“…It is described as orthostatic HA caused by low CSF pressure of spontaneous origin [ 24 ]. It is usually accompanied by neck stiffness, subjective hearing symptoms, nausea, and vomiting [ 23 ]. The diagnostic criteria for SIH are listed in Table 4 .…”

“…Imaging techniques for detecting the CSF leak are brain/spinal MRI, CT myelography, MR myelography, and radioisotope cisternography [ 1 ]. The best tool for diagnosing SIH is brain MRI with contrast enhancement [ 23 ]. MRI may reveal diffuse pachymeningeal enhancement (73%), venous engorgement (57%), brain sagging (43%), subdural fluid collection (35%), and pituitary hyperemia (38%) in SIH [ 1 , 10 , 11 , 23 , 24 , 26 , 27 ].…”