CT-guided epidural blood patching for the treatment of spontaneous intracranial hypotension
Manolis Polemikos (Hannover), Frank Donnerstag (Hannover), Heinrich Lanfermann (Hannover), Joachim K. Krauss (Hannover)
Spontaneous intracranial hypotension (SIH) is a disorder characterized by incapacitating postural headaches resulting from a spontaneous spinal cerebrospinal fluid (CSF) leak. While Epidural Blood Patching (EBP) is a well-established intervention in the treatment of SIH, the optimal approach remains uncertain due to the diverse techniques employed. The aim of this study was to evaluate the efficacy of CT-guided EBP in the treatment of SIH.
All patients with SIH who were treated from 2010 to 2022 in our hospital were retrospectively analyzed. A 22G Tuohy needle was advanced under CT-guidance in the epidural space using the loss-of-resistance technique. To confirm accurate needle tip placement in the epidural compartment, a small amount of contrast medium was injected. EBP procedures were conducted as either non-targeted or targeted deliveries. The volume of sterile autologous blood injected varied and was primarily determined by patients" feedback during the procedure or through retrograde blood flow when the procedure was performed in general anesthesia.
Among forty-eight patients (37 women and 11 men) treated for SIH, 16 underwent not-targeted and 32 underwent a targeted EBP at a median age of 49 years (range 40-74 years). In the targeted EBP group, 15 patients received single-level EBP, 14 had a two-level procedure and 1 underwent a three-level EBP. The median duration of symptoms prior EBP was 4 weeks (range 2 days - 215 weeks). The response rate after the first EBP was 75% (12/16) in the not-targeted and 90% (29/32) in the targeted group. In the not-targeted group, 3/4 patients exhibited improvement after a second EBP, resulting in an overall response rate of 94%. In the targeted group, each one patient improved after a second and a third EBP, leading to an overall response rate of 97% (31/32). Adverse events included 2 cases of transient rebound intracranial hypertension and one instance of transient radiculopathy.
Our results emphasize the efficacy of CT-guided EBP in managing SIH, with a minimal incidence of transient adverse events.
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