Two-site blind epidural blood patch versus targeted epidural blood patch in spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH), caused by CSF leaks, can trigger headaches, and is treated using epidural blood patch (EBP) procedures. We aimed to determine the effectiveness of a newly devised two-site blind EBP procedure as the initial treatment for SIH and compare its effectiveness with that of conventional targeted EBP. We retrospectively reviewed data for 116 patients who underwent EBP for SIH between November 2013 and April 2017. Patients were divided into two groups: those who initially received two-site blind EBP (n = 28) at the cervicothoracic (C7/T1) and thoracolumbar junctions (T12/L1) for sealing CSF leaks at all levels, and those who received targeted EBP after CT myelography (n = 88). The initial recovery status and the need for additional blood patches were evaluated. In total, 71.4% and 69.3% patients in the two-site blind EBP and targeted EBP groups, respectively, experienced complete relief after the first patch (p > .05): collectively, 89.3% and 96.6% patients, respectively, experienced complete or partial relief after the first patch (p > .05). A second EBP was required by 35.7% and 29.5% patients in the two-site blind EBP and targeted EBP groups, respectively, with no significant between-group difference (p > .05). All patients ultimately experienced relief; a few required up to four patches. We observed similar outcomes after initial two-site blind EBP and targeted EBP. Therefore, two-site blind EBP is an effective alternative to conventional targeted EBP and a potential initial patch of choice for SIH treatment. (C) 2018 Elsevier Ltd. All rights reserved.