gms | German Medical Science

Objective: Spontaneous intracranial hypotension (SIH) is an increasingly diagnosed disorder. Conservative treatment measurements are followed by the epidural blood patch (EBP) procedure. EBP is considered as an established, safe and effective treatment. Surgery is the last treatment option. Here, we sought to evaluate the outcome of SIH patient, who underwent an EBP procedure.

Methods: We retrospectively analyzed data from 19 SIH patients, who were treated in our institution between 2012 to 2021. Demographic characteristics, imaging findings, effectiveness of EBP and outcome data were collected.

Results: Our study cohort comprised 13 female (68.4%) and 6 male (31.6%) patients with a mean age of 42.1 years (range, 26.9 to 58.7 years). 63% of the cases (n= 12) were diagnosed with a SIH after 2019. The leading symptom was orthostatic headache (n= 16, 84.2%), followed by neck pain (n= 5, 26.3%) and vestibulocochlear symptoms (n= 5, 26.3%). 17 patients (89.5%) developed subdural hygromas/hematomas, of whom five were symptomatic (29.4%), prompting surgical evacuation (three surgeries after and two before EBPs). Spinal imaging identified CSF collection at the retrospinal region at C1-2 level in all patients. A longitudinal extradural spinal CSF collection was present in 15 (83.3%) cases. Cerebellar tonsillar ectopia was revealed in four patients (21.1%). A CT myelography was performed in four cases (21.1%). Subsequently, the site of CSF leakage was successfully traced in two patients (10.5%), both with leakage in a thoracic location. 8 patients (42.1%) have received a single EBP, 6 patients (31.6%) 2 EBPs, 4 patients (21.1%) 3 EBPs and one patient (5.3%) 5 EBPs. The EBPs were performed 28 times via the lumbar spine, 4 times at a thoracic level and in two cases suboccipitally. The administered blood volume varied between 10-35 ml. One patient underwent surgical closure of a longitudinal dural slit due to permanent, unimproved neurological symptoms despite EBPs. 8 patients demonstrated a complete remission of symptoms immediately after treatment and 10 patients showed a clinical improvement.

Conclusion: Spontaneous intracranial hypotension is a manageable disorder and clinicians should be aware of SIH correlated symptoms. EBP is a highly effective therapeutic procedure, if conservative treatment fails. In our series, surgery was required in a single case due to EBP failure.