J Korean Soc Radiol.  2014 Apr;70(4):299-305. 10.3348/jksr.2014.70.4.299.

Comparison of the Efficacy of Epidural Autologous Blood Patch in the Treatment of Spontaneous Intracranial Hypotension and Post-Dural Puncture Headache

Affiliations
  • 1Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea. netty0523@gmail.com

Abstract

PURPOSE
To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH).
MATERIALS AND METHODS
Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05).
RESULTS
In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief.
CONCLUSION
Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.


MeSH Terms

Blood Patch, Epidural
Female
Headache
Humans
Intracranial Hypotension*
Male
Medical Records
Post-Dural Puncture Headache*
Recurrence
Treatment Outcome

Figure

  • Fig. 1 A 30-year-old male patient who was diagnosed as spontaneous intracranial hypotension. Postmyelography CT revealing extradural spreading of contrast medium around the right nerve root C7 (open arrow) and anterior epidural space at the C7/T1 level (arrow).

  • Fig. 2 A 38-year-old male patient who was diagnosed as spontaneous intracranial hypotension. Extradural contrast medium leakage was seen at multilevel. Epidural blood patch was done at L3/4 where extradural spreading of contrast medium was extensive. A. Postmyelography CT revealing extradural spreading of contrast medium in the epidural space at the L3/4 level and extension to outside of the spinal canal (arrows). B. Postmyelography CT revealing extradural spreading of contrast medium in the epidural space at the L4/5 level (arrow) and around the left nerve root L4 (open arrow). C. Postmyelography CT revealing extradural spreading of contrast medium (arrow) in the anterior epidural space at the L5/S1 level.


Cited by  1 articles

The Efficacy of a Fluoroscopy Guided Epidural Autologous Blood Patch In the Treatment of a Post-Dural Puncture Headache
Ji Eun Park, Eugene Lee, Joon Woo Lee, Yusuhn Kang, Joong Mo Ahn, Heung Sik Kang
J Korean Soc Radiol. 2018;78(4):242-248.    doi: 10.3348/jksr.2018.78.4.242.


Reference

1. Kokki M, Sjövall S, Kokki H. Epidural blood patches are effective for postdural puncture headache in pediatrics--a 10-year experience. Paediatr Anaesth. 2012; 22:1205–1210.
2. Kawaguchi M, Hashizume K, Watanabe K, Inoue S, Furuya H. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth. 2011; 25:450–453.
3. van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry. 2008; 79:553–558.
4. Allmendinger AM, Lee TC. Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch. Clin Imaging. 2013; 37:756–761.
5. Mokri B. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache. 2013; 53:1034–1053.
6. Watanabe K, Hashizume K, Kawaguchi M, Fujiwara A, Sasaoka N, Furuya H. Fluoroscopically guided epidural blood patch with subsequent spinal CT scans in the treatment of spontaneous cerebrospinal fluid hypovolemia. J Neurosurg. 2011; 114:1731–1735.
7. Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001; 95:334–339.
8. Williams EJ, Beaulieu P, Fawcett WJ, Jenkins JG. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth. 1999; 8:105–109.
9. Albes G, Weng H, Horvath D, Musahl C, Bäzner H, Henkes H. Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension. Neuroradiology. 2012; 54:1367–1373.
10. 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; 32:832–838.
11. Gormley JB. Current comment: treatment of postspinal headache. Anesthesiology. 1960; 21:565–566.
12. Sencakova D, Mokri B, McClelland RL. The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology. 2001; 57:1921–1923.
13. Vilming ST, Titus F. Low cerebrospinal fluid pressure. In : Olefson J, Tfelt-Hansen P, Welch KMA, editors. The Headache. New York: Raven Press;1993. p. 687–695.
14. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia. 2008; 28:1345–1356.
15. Buvanendran A, Byrne RW, Kari M, Kroin JS. Occult cervical (C1-2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch. J Neurosurg Spine. 2008; 9:483–487.
16. Vanopdenbosch LJ, Dedeken P, Casselman JW, Vlaminck SA. MRI with intrathecal gadolinium to detect a CSF leak: a prospective open-label cohort study. J Neurol Neurosurg Psychiatry. 2011; 82:456–458.
17. Albayram S, Kilic F, Ozer H, Baghaki S, Kocer N, Islak C. Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome. AJNR Am J Neuroradiol. 2008; 29:116–121.
18. Kapoor R, Liu J, Devasenapathy A, Gordin V. Gadolinium encephalopathy after intrathecal gadolinium injection. Pain Physician. 2010; 13:E321–E326.
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