Efficacy of CT Guided Epidural Blood Patch for Spontaneous Intracranial Hypotension: a Case Series

Authors

  • Nischala Dixit DNB Anaesthesiology, MRCA, Professor, Department of Anaesthesia, St John's Medical College & Hospital, Bengaluru, India
  • Gifty Susan Philip DNB Anaesthesiology, Assistant Professor, Department of Anaesthesia, St John's Medical College & Hospital, Bengaluru, India
  • Sai Kanth Deepalam MD, DM, Assistant Professor, Department of Interventional Radiology, St John's Medical College & Hospital, Bengaluru, India
  • Anna Mary George PG Resident, Department of Anesthesia, St John's Medical College & Hospital, Bengaluru, India
  • Shilpa Bhimasen Joshi DNB Anaesthesiology, Associate Professor, Department of Anaesthesia, St John's Medical College & Hospital, Bengaluru, India
  • Anas P MD Anaesthesiology,Senior Resident, Department of Anesthesia, St John's Medical College & Hospital, Bengaluru, India

DOI:

https://doi.org/10.31636/pmjua.v10i1-2.3

Keywords:

spontaneous intracranial hypotension (SIH), cerebrospinal fluid (CSF) leak, orthostatic headache, epidural blood patch, targeted epidural blood patch, CT myelography

Abstract

Incidence of Supine intracranial hypotension(SIH) is 5/100000 in a year and is more common in females. It presents with postural headache secondary to structural dural weakness resulting in atraumatic cerebrospinal fluid leak. Variable treatment modalities exist however, targeted image guided autologous Epidural blood patch(EBP) has proven to be more effective in relieving the symptoms. Six patients diagnosed with SIH presented to us with failure of conservative management and were successfully treated with CT guided targeted EBP with immediate resolution of their symptoms. Targeted image guided epidural blood patch seems to be a promising treatment modality in patients with SIH after failure of conservative strategies

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References

1. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295:2286–96.

2. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks: a review. Neurosurg Focus 2000; 9: e8.

3. Schievink W. Misdiagnosis of spontaneous intracranial hypotension. JAMA Neurol 2003;60:1713–8.

4. Syed NA, Mirza FA, Pabaney AH, Rameez-uh-Hassan. Pathophysiology and management of spontaneous intracranial hypotension — A review. J Pak Med Assoc 2012;62:51–5.

5. Zada G, Solomon TC, Giannotta SL (2007) A review of ocular manifestations in intracranial hypotension. Neurosurg Focus 23: E8.

6. Lydia LW, Ofelia LY, Jasmine CL, Joseph A (2021) Epidural Blood Patch for Spontaneous Intracranial Hypotension. Int J Anesthetic Anesthesiol 8:126. doi.org/10.23937/2377–4630/1410126

7. Kranz P, Gray L, Amrhein T. Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions. Headache. 2018;58(7):948–59

8. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition:. (2018) Cephalalgia. 38 (1): 1–211.

9. Schmahmann J &Schievink W. Compulsive Repetitive Flexion With Breath-Holding in Sagging Brain Syndrome. Neur Clin Pract. 2024;14(2)

10. Schievink W & Maya M. Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension. Headache. 2008;48(10):1511–9.

11. Moon Ok Lee, Sung Yup Jin, Sung Bo Shim, Ji Hoon Lee. Spontaneous Intracranial Hypotension Treated with Epidural Blood Patch: A Case Report. Soonchunhyang Medical Science (SMS) 2023; 29(1): 19–22.

12. Kranz PG, Tanpitukpongse TP, Choudhury KR, Amrhein TJ, Gray L. How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension? Cephalalgia. 2016 Nov;36(13):1209–1217.

13. Gaillard F, Sharma R, Campos A, et al. Spontaneous intracranial hypotension. Reference article, Radiopaedia.org (Accessed on 25 Sep 2024) https://doi.org/10.53347/rID-1519

14. Farb R, Nicholson P, Peng P et al. Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography. AJNR Am J Neuroradiol. 2019;40(4):745–53

15. Dobrocky T, Grunder L, Breiding P et al. Assessing Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension with a Scoring System Based on Brain Magnetic Resonance Imaging Findings. JAMA Neurol. 2019;76(5):580.

16. Wang DJ, Pandey SK, Lee DH, Sharma M. The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI. AJNR Am J Neuroradiol. 2019 Aug;40(8):1299–1303

17. Kranz PG, Gray L, Taylor JN. CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2011 May;32(5):832–8.

18. Shin HY. Recent update on epidural blood patch. Anesth Pain Med (Seoul). 2022 Jan;17(1):12–23. doi: 10.17085/apm.21113. Epub 2022 Jan 18. PMID: 35038855; PMCID: PMC8841262.

19. Piechowiak EI, Aeschimann B, Häni L, Kaesmacher J, Mordasini P, Jesse CM et al. Epidural Blood Patching in Spontaneous Intracranial Hypotension-Do we Really Seal the Leak? Clin Neuroradiol. 2023 Mar;33(1):211–218. doi: 10.1007/s00062–022–01205–7

20. Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG. Clinical experiences with spontaneous intracranial hypotension: a proposal of a diagnostic approach and treatment. Clin NeurolNeurosurg2011;113:373–9

21. Wang E, Wang D. Successful treatment of spontaneous intracranial hypotension due to prominent cervical cerebrospinal fluid leak with cervical epidural blood patch. Pain Med 2015;16:1013–8

22. Leung LWL, Chan YCD, Chan TMD. Lumbar epidural blood patch: An effective treatment for intracranial hypotension. SurgNeurol Int. 2022 Nov 11;13:517.

23. Feltracco P, Galligioni H, Barbieri S, Ori C. Thoracic Epidural Blood Patches in the Treatment of Spontaneous Intracranial Hypotension: A Retrospective Case Series. Pain Physician. 2015 Jul-Aug;18(4):343–8. PMID: 26218937.

Efficacy of CT Guided Epidural Blood Patch for Spontaneous Intracranial

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Published

2025-12-31

How to Cite

1.
Dixit N, Philip GS, Deepalam SK, George AM, Joshi SB, P A. Efficacy of CT Guided Epidural Blood Patch for Spontaneous Intracranial Hypotension: a Case Series. PMJUA [Internet]. 2025 Dec. 31 [cited 2026 Mar. 21];10(1-2):27-32. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/370

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