Retrospective Study of Epidural Blood Patch Use for Spontaneous Intracranial Hypotension

Joo, Eun Young; Hwang, Bo Young; Kong, Yu Gyeong; Lee, Jong Hyuk; Hwang, Beom Sang; Suh, Jeong Hun

doi:10.1097/aap.0000000000000194

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…In our previous study, we found that the response to autologous EBP was related to the severity of symptoms but not to the number and location of CSF leakages. 21 One of the limitations of our previous study was that we only dealt with the number of leakage sites without any quantitative analysis of the amount of leakage because there are no proper tools to measure this. 21 We, therefore, decided to use 6 surrogate markers of the quantitative evaluation of leakage based on previous studies.…”

Section: Discussionmentioning

confidence: 99%

“… 21 One of the limitations of our previous study was that we only dealt with the number of leakage sites without any quantitative analysis of the amount of leakage because there are no proper tools to measure this. 21 We, therefore, decided to use 6 surrogate markers of the quantitative evaluation of leakage based on previous studies. 1 , 2 , 22 The first marker was derived from the study of Morioka et al 1 who evaluated four indirect findings of CSF leakage on RI cisternography, such as the early visualization of bladder activity, no visualization of activity over the brain convexities, rapid disappearance of spinal activity, and abnormal visualization of the root sleeves.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch

Karm

Choi²,

Kim³

et al. 2016

Medicine

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Spontaneous intracranial hypotension (SIH) is characterized by postural headache because of low cerebrospinal fluid (CSF) pressure. Brain magnetic resonance imaging (MRI) and radioisotope (RI) cisternography can be used to identify the site of a CSF leakage. Although autologous epidural blood patch (EBP) is a very effective treatment modality, some patients require a repeat autologous EBP. We investigated whether autologous EBP responses correlate with surrogate markers of quantitative findings.All cases of autologous EBP for SIH from January 2006 to December 2014 were enrolled. The demographic variables, number of EBPs, pain scores, RI cisternography (early visualization of bladder activity), and MRI findings (subdural fluid collections, pachymeningeal enhancement, engorgement of venous structures, pituitary hyperemia, and sagging of the brain) were reviewed.Patients with early bladder activity on RI cisternography had a tendency to need a higher number of autologous EBPs. Only sagging of the brain and no other variables showed a statistically significant negative correlation with the number of autologous EBPs.The response to autologous EBP may be related to the radiologic findings of early bladder activity on RI cisternography and sagging of the brain on MRI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch

Karm

Choi²,

Kim³

et al. 2016

Medicine

Self Cite

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“…21 However, many patients require more than one EBP or other treatments such as epidural saline/ fibrin glue infusion and IT fluid infusion. [22][23][24][25][26] In the present study we aimed to elucidate predictors of a positive response to an EBP based on clinical characteristics, subjective symptoms, and neuroradiological signs, which revealed that these predictors were age, interval from the onset to EBP application, rate of RI remaining after 24 hours, epidural CSF collection in MRI, epidural CFS leak in RI cisternography, orthostatic headache, nuchal pain, photophobia, and nausea. Our finding that being younger and having a shorter interval from the onset to EBP application were significant predictors suggests that spinal CSF leakage should be treated early.…”

Section: Jcnmentioning

confidence: 99%

Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

et al. 2020

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Background and Purpose An epidural blood patch (EBP) is a highly effective therapy for spinal cerebrospinal fluid (CSF) leakage. However, the factors predicting the response to an EBP have not been fully elucidated. The aim of this study was to elucidate factors predicting the response to an EBP. Methods We retrospectively examined the relationship between the response to an EBP and clinical variables of 118 patients with spinal CSF leakage, such as patient age, sex, etiology, interval from the onset to EBP application, CSF opening pressure (OP), radioisotope (RI) cisternography findings, rate of RI remaining in the CSF space, computed tomography (CT) myelography findings, magnetic resonance imaging (MRI) findings, and subjective symptoms (headache, vertigo/dizziness, visual disturbance, nausea, numbness, nuchal pain, back pain/lumbago, fatigability, photophobia, and memory disturbance). The correlations between these variables and the responses to EBPs were analyzed statistically. Results A positive response to an EBP was significantly (p<0.05) correlated with the following variables: <1.5 years from the onset to EBP application, age <40 years, CSF OP <7 cm H2O, epidural CSF leakage in RI cisternography, epidural CSF collection in MRI, <20% RI remaining after 24 hours, orthostatic headache, nausea, nuchal pain, and photophobia. The other variables did not show significant correlations with the responses to EBPs. Conclusions It might be prudent to take the following variables into account when applying an EBP to treat spinal CSF leakage: the interval from the onset to EBP application, age, CSF OP, epidural CSF leakage in RI, epidural CSF collection in MRI, rate of remaining RI, orthostatic headache, nuchal pain, photophobia, and nausea.

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“…2). Nicht selten weisen die Patienten 2 oder auch mehrere Liquorlecks auf [1,11]. Neben dem primären Einriss der Dura sind es häu-fig zystisch erweiterte Wurzeltaschen, die sich als Locus minoris resistentiae erweisen und zum Liquorleck führen.…”

Section: Diagnostik Des Liquorunterdrucksyndromsunclassified

“…Je nach Compliance des Patienten können diese jedoch in einer einzelnen Sitzung appliziert werden. In einer aktuellen Studie zur Wirksamkeit des "blood patch" ergab sich als Ergebnis, dass die insgesamt benötigte Anzahl an "blood patches" nicht mit der Anzahl der Liquorleckagen korreliert, hierfür aber signifikant mit dem ursprünglichen Schweregrad der Beschwerden vor Therapiebeginn [11].…”

Section: Ergebnisseunclassified

Liquorverlustsyndrom

Gottschalk

2015

Radiologe

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Retrospective Study of Epidural Blood Patch Use for Spontaneous Intracranial Hypotension

Abstract: Our study suggests that the response to the EBP is related to the severity of symptoms but not to the number and locations of cisternographic CSF leakages.

Cited by 9 publications

References 25 publications

Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch

Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch

Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

Liquorverlustsyndrom

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