Open AccessThoracic Epidural Blood Patches in the Treatment of Spontaneous Intracranial Hypotension: A Retrospective Case Series
Author(s) -
Paolo Feltracco,
Helmut Galligioni,
Stefania Barbieri,
Carlo Ori
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/343
Subject(s) - medicine , headaches , retrospective cohort study , orthostatic vital signs , lumbar , sitting , surgery , epidural blood patch , anesthesia , spontaneous intracranial hypotension , thoracic vertebrae , lumbar vertebrae , cerebrospinal fluid , blood pressure , radiology , complication , pathology
Background: Spontaneous intracranial hypotension (SIH) results from leaks developing in thedura mater. The major symptom is orthostatic headache which gradually disappears after lyingdown. Lumbar epidural blood patches (EBPs) can be effective in relieving headaches, however,thoracic and cervical EBPs have also been applied to alleviate the symptoms.Objective and Methods: Retrospective collection of the main characteristics of SIH, site andamount of blood injection, and clinical outcomes of 18 patients who underwent thoracic EBPs forintractable SIH. {Study Design: Retrospective case seriesResults: All thoracic autologous EBPs except 3 were performed in the sitting position. Patientsundergoing epidural puncture at lower thoracic levels (T10-T12) received 25 mL of autologousblood, 15 mL and 18 mL were injected at spinal segments T5-T7 (mid-thoracic) and T2-T4 (upperthoracic), respectively. Thoracic EBPs did not lead to immediate resolution of symptoms in 3 of 18patients; one of them underwent early repetition with complete headache relief, one refused asecond EBP, and one experienced partial resolution, followed by a recurrence, and then satisfactoryimprovement with a second high thoracic EBP. In long-term follow-up only 2 patients complainedof symptoms or relapses.Limitations: Retrospective nature of the case series, single center experience.Conclusions: Performing thoracic-targeted EBPs as the preferred approach theoretically improvesresults with respect to those observed with lumbar EBPs. The immediate response was comparablewith that of other reports, but the long-term success rate (90%) turned out to be very effective interms of both quality of headache relief and very low incidence of recurrence.Key words: Central pain, cerebrospinal fluid leak, headache disorders, low intracranial pressuresyndrome, epidural blood patch, occipital headache