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

Piechowiak, Eike I; Aeschimann, Benjamin; Häni, Levin; Kaesmacher, Johannes; Mordasini, Pasquale; Jesse, Christopher Marvin; Schankin, Christoph J; Raabe, Andreas; Schär, Ralph T; Gralla, Jan; Beck, Jürgen; Dobrocky, Tomas (2022). Epidural Blood Patching in Spontaneous Intracranial Hypotension-Do we Really Seal the Leak? (In Press). Clinical neuroradiology Springer-Verlag 10.1007/s00062-022-01205-7

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PURPOSE

Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spinal CSF leaks in SIH patients after non-targeted EBP.

METHODS

Patients with SIH and a confirmed spinal CSF leak who had been treated with non-targeted EBP were retrospectively analyzed. Primary outcome was persistence of CSF leak on spine MRI or intraoperatively. Secondary outcome was change in clinical symptoms after EBP.

RESULTS

In this study 51 SIH patients (mean age, 47 ± 13 years; 33/51, 65% female) treated with non-targeted EBP (mean, 1.3 EBPs per person; range, 1-4) were analyzed. Overall, 36/51 (71%) patients had a persistent spinal CSF leak after EBP on postinterventional imaging and/or intraoperatively. In a best-case scenario accounting for missing data, the success rate of sealing a spinal CSF leak with an EBP was 29%. Complete or substantial symptom improvement in the short term was reported in 45/51 (88%), and in the long term in 17/51 (33%) patients.

CONCLUSION

Non-targeted EBP is an effective symptomatic treatment providing short-term relief in a substantial number of SIH patients; however, successful sealing of the underlying spinal CSF leak by EBP is rare, which might explain the high rate of delayed symptom recurrence. The potentially irreversible and severe morbidity associated with long-standing intracranial hypotension supports permanent closure of the leak.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Piechowiak, Eike Immo; Häni, Levin; Kaesmacher, Johannes; Mordasini, Pasquale; Jesse, Christopher Marvin; Schankin, Christoph Josef; Raabe, Andreas; Schär, Ralph Thomas; Gralla, Jan; Beck, Jürgen and Dobrocky, Tomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1439

Publisher:

Springer-Verlag

Language:

English

Submitter:

Pubmed Import

Date Deposited:

29 Aug 2022 13:31

Last Modified:

29 Aug 2022 13:41

Publisher DOI:

10.1007/s00062-022-01205-7

PubMed ID:

36028627

Uncontrolled Keywords:

Cerebrospinal fluid leak Epidural blood patch Spontaneous intracranial hypotension

BORIS DOI:

10.48350/172445

URI:

https://boris.unibe.ch/id/eprint/172445

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