Epidural Blood Patching in Spontaneous Intracranial Hypotension—Do we Really Seal the Leak?

Piechowiak, Eike Immo; Aeschimann, Benjamin; Häni, Levin; Kaesmacher, Johannes; Mordasini, Pasquale; Jesse, Christopher Marvin; Schankin, Christoph; Raabe, Andreas; Schär, Ralph T.; Gralla, Jan; Beck, Jürgen; Dobrocky, Tomas

doi:10.1007/s00062-022-01205-7

Cited by 13 publications

(7 citation statements)

References 32 publications

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“…Several studies reported low success rates due to failures in identifying the exact location of the CSF leak and blind injection of EBP. 5,12 CT myelograms and Tc99 DTPA scans are required to determine the precise location and number of CSF leaks. 4,10 Spinal leaks that occur ventrally cannot be effectively managed by EBP injection via an interlaminar approach because they cause compression dorsally, resulting in low success rates.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Saranraj

Giridharan

Nathan

et al. 2023

Indian Journal of Neurosurgery

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Introduction Spontaneous intracranial hypotension (SIH) is a misdiagnosed condition characterized by low cerebrospinal fluid (CSF) volume and an orthostatic headache that worsens with upright posture due to CSF leak at spinal dural defects. SIH due to CSF leak at multiple spinal levels is a rare condition, and only a few cases have been reported in the literature. Here, we report a case of SIH with a CSF leak at multiple spinal levels. The treatment options and efficacy of epidural blood patch (EBP) injection were discussed in this article. Case Report A 36-year-old man presented with complaints of orthostatic headache for 2 months and a computed tomography myelogram demonstrated CSF leaks at multiple spinal levels through the dural defects at C5-C6, C6-C7, C7-T1, T1-T2 levels, and at L1, L2, L3, and L4 vertebral levels on the left side. He was managed with a targeted EBP injection and he improved symptomatically within 24 hours of the EBP injection. Summary SIH is an entity that results from CSF leakage, often through spinal dural defects due to mechanical tear by osteophyte complex, disc prolapse, connective tissue disorders, CSF-venous fistula, and leaking meningeal diverticula. SIH can result from single or multiple dural leaks, but spinal leaks at multiple levels are uncommon. To the best of our knowledge, a total number of 163 cases have been reported in the literature so far. With good success rates, targeted EBP injection with autologous blood is an effective treatment option for both single-level and multiple-level spinal leaks.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Saranraj

Giridharan

Nathan

et al. 2023

Indian Journal of Neurosurgery

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“…Several treatment strategies are available to manage SIH. These include conservative measures, targeted epidural blood patches, and lastly surgical treatment [4,6,8]. Due to the lack of randomized controlled trials, the choice of treatment depends solely on the preference and expertise of the physician [4].…”

Section: Discussionmentioning

confidence: 99%

“…To achieve the required mechanism of epidural patching, 10-20 ml of blood tend to be used. It acts in the spinal epidural space, restricting the CSF flow, and dural tamponade to seal the CSF leak sites [4,9] This procedure can be repeated more than once with intervals of 5 days and a large amount of blood should be during the repeated setting [4,8]. In the presented case, cervical-targeted EBP was performed after a failed trial of conservative options (The intraoperative details of the performed EBP were mentioned in the case presentation section).…”

Section: Discussionmentioning

confidence: 99%

“…Variable treatment options are available, including conservative measures, epidural blood patching, and lastly surgical techniques [4,6,7]. Multiple studies demonstrate the effectiveness of epidural blood patch (EBP) in managing SIH symptomatology [8,9]. In our review of the latest english literature worldwide, the terms were used "spontaneous intracranial hypotension", "CSF leak", epidural blood patch", "lowpressure headache", and "CSF hypovolemia" to search in PubMed.…”

Section: Introductionmentioning

confidence: 99%

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Hypotension of The Intracranial Circulation with CSF Leakage: A Rare Etiology of Misdiagnosed Orthostatic Headache; Using A Successful Blood Patching Technique: A Case Report and Literature Review

Saleem,

Alenezi

et al. 2023

AJSCR

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Background: Spontaneous intracranial hypotension (SIH) is typically caused by spontaneous spinal leakage of the CSF, with unknown exact etiology, causing CSF volume depletion and craniospinal elasticity alterations. Often, SIH is misdiagnosed condition. Case Presentation: A 37-year-old female patient, presented with a four-month history of severe headaches. The first attack of headache, which was preseeded by one month of tinnitus, was in the fifth month of pregnancy. Physical examination and laboratory investigations were unremarkable. Brain MRI with and without contrast revealed thick diffuse meningeal enhancement. The MRA and MRV studies were unremarkable. Then, the patient’s headache worsens despite conservative therapy. MRI myelogram revealed a leak from the cervical nerve roots. Once the location of the leak was confirmed, a cervical epidural blood patch was performed successfully. The postoperative period, four days, was uneventful with clinical improvement of the patient’s headache and tinnitus. Discussion: Spontaneous intracranial hypotension is a challenging event that requires rapid diagnosis and management. Usually, the clinical history is suggestive of SIH diagnosis but still, it is underdiagnosed. Both imaging modalities and diagnostic criteria are important diagnostic tools for SIH. Several treatment modalities are available, including conservative options, epidural blood patches, and surgical intervention. Conclusion: Targeted epidural blood patch is a valid approach to managing the SIH that has been performed after a failed trial of conservative measures. We report a 37-year-old patient with a 4-month history of severe headaches and tinnitus found to be caused by SIH and managed by a cervical epidural blood patch.

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“…However, its efficacy, actually varies from 55 to 75%, depending on the specific cause of the dural pathology and the conditions of its application performed [ 6 , 7 ]. Moreover, even if clinical improvement occurs in the early follow-up period, persisting CSF loss may perpetuate the disease and potentially result in severe long-term morbidity [ 8 , 9 ]. Notably, the persistent form of PDPH (pPDPH), while clinically observed [ 7 , 9 ], is not formally recognized in the International Classification of Headache Disorders 3rd Edition (ICHD-3).…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life, work ability and disability among individuals with persistent post-dural puncture headache

Kapan,

Waldhör,

Schiffler

et al. 2024

J Headache Pain

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Background and objectives Postdural puncture headache (PDPH) is an acknowledged consequence of procedures like lumbar punctures, epidural analgesia, and neurosurgical interventions. Persistence over more than three months, however has been poorly studied. In particular, little is known about the impact of persistent PDPH (pPDPH) on health related quality of life (HRQoL), disability and ability to work. The study aimed to provide a holistic understanding of pPDPH, encompassing medical, physical and psychological aspects. Methods We conducted a cross-sectional anonymous online survey in individuals aged 18 or older, diagnosed with, or suspected to have pPDPH via self-help groups on Facebook. Participants completed a structured questionnaire covering diagnosis, symptoms, and the ability to work. For assessing headache related disability, and mental health, they filled in the Henry Ford Hospital Headache Disability Inventory (HDI) and the Depression Anxiety Stress Scale-21 (DASS-21). Results A total of 179 participants (83.2% female, mean age 39.7 years) completed the survey. PPDPH had been present for one year or more in 74.3%, and 44.1% were unable to be in an upright position for more than one hour per day without having to lie down or sit down. Headaches were extremely severe or severe in 18% and 34%, respectively. According to the HDI, 31.8% of participants had mild, 25.7% moderate, and 42.5% severe disability. DASS-21 revealed substantial mental health challenges with depression, anxiety and stress experienced by 83%, 98%, and 88% of the respondents. The ability to work was limited considerably: 27.9% were unable to work, 59.8% worked part-time, 1.1% changed their job because of pPDPH, and only 11.2% were able to work full-time in their previous job. Despite treatment, the patients’ condition had deteriorated in 32.4% and remained unchanged in 27.9%. Conclusion This study stresses the burden of pPDPH in terms of substantial disability, limited quality of life, mental health concerns, and significant impact on the ability to work. The study highlights the long-term impact of pPDPH on individuals, emphasizing the need for timely diagnosis and effective treatment. It underscores the complexity of managing pPDPH and calls for further research into its long-term effects on patient health and HRQoL.

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Epidural Blood Patching in Spontaneous Intracranial Hypotension—Do we Really Seal the Leak?

Cited by 13 publications

References 32 publications

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Hypotension of The Intracranial Circulation with CSF Leakage: A Rare Etiology of Misdiagnosed Orthostatic Headache; Using A Successful Blood Patching Technique: A Case Report and Literature Review

Health-related quality of life, work ability and disability among individuals with persistent post-dural puncture headache

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