Targeted Epidural Blood Patch Treatment for Refractory Spontaneous Intracranial Hypotension in China

Journal of Neurological Surgery. Part B, Skull Base
Fei-fang HeXiang-Ming Fang

Abstract

Objective  An epidural blood patch (EBP) is the mainstay of treatment for refractory spontaneous intracranial hypotension (SIH). We evaluated the treatment efficacy of targeted EBP in refractory SIH. Methods  All patients underwent brain magnetic resonance imaging (MRI) with contrast and heavily T2-weighted spine MRI. Whole spine computed tomography (CT) myelography with non-ionic contrast was performed in 46 patients, and whole spine MR myelography with intrathecal gadolinium was performed in 119 patients. Targeted EBPs were placed in the prone position one or two vertebral levels below the cerebrospinal fluid (CSF) leaks. Repeat EBPs were offered at 1-week intervals to patients with persistent symptoms, continued CSF leakage, or with multiple leakage sites. Results  Brain MRIs showed pachymeningeal enhancement in 127 patients and subdural hematomas in 32 patients. One hundred fifty-two patients had CSF leakages on heavily T2-weighted spine MRIs. CSF leaks were also detected on CT and MR myelography in 43 and 111 patients, respectively. Good recovery was achieved in all patients after targeted EBP. No serious complications occurred in patients treated with targeted EBP during the 1 to 7 years of follow-up. Conclusions  Targete...Continue Reading

Citations

Apr 28, 2020·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Carlos Perez-VegaVictor Garcia Navarro
Mar 20, 2019·Current Neurology and Neuroscience Reports·Parth Upadhyaya, Jessica Ailani
Nov 5, 2019·Clinical Neuroradiology·Bianca BesteherMatthias Schwab
Dec 1, 2020·Magnetic Resonance in Medical Sciences : MRMS : an Official Journal of Japan Society of Magnetic Resonance in Medicine·Shinji Naganawa, Toshiaki Taoka

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