Spontaneous intracranial hypotension Efficacy of radiologic targeting vs blind blood patch

Objective: The aim of this study was to evaluate the efficacies and compare the outcomes of targeted and blind epidural blood patch (EBP) treatments of spontaneous intracranial hypotension (SIH). Methods: Between January 1999 and December 2009, 56 patients who were diagnosed with SIH received either a targeted or blind EBP. The efficacies of targeted and blind EBPs were evaluated based on degree and duration of symptom relief and on the need for repeat EBP. Results: Fifty-six patients (23 men and 33 women; mean age, 39.6 years; age range, 22-69 years) were included in this study. Thirty-one patients received EBP that targeted CSF leak segments, and 25 received a blind EBP because primary CSF leak sites were not identified (19 patients via a lumbar epidural route, mainly the L 3-4 level, regardless of primary CSF leak site, and 6 patients via upper thoracic epidural spaces, mainly the T4-6 level). In the 31 patients who received a targeted EBP, 27 (87.1%) exhibited clinical improvement after first administration. In contrast, 13 of the 25 patients (52%) who received a blind EBP via a lumbar or upper thoracic epidural route achieved complete recovery. Targeted EBPs were more effective than blind EBPs for the treatment of SIH (p < 0.05). Conclusions: EBPs targeting CSF leaks can be safely placed under fluoroscopic guidance in patients with SIH and are more likely to be effective than blindly placed EBPs. Neurology (R) 2011;76:1139-1144