Clinical effect of cervical vs. targeted epidural blood patch in spontaneous intracranial hypotension with unclear leakage sites

Abstract

Background and Aims: Epidural blood patch (EBP) is the most commonly used treatment for spontaneous intracranial hypotension (SIH). EBP is generally targeted at the cerebrospinal fluid (CSF) leakage site; in unclear leakage sites, it is performed blindly in the lumbar region. Therefore, to investigate effectiveness of cervical EBP in SIH patients having unclear CSF leakage sites, we conducted a retrospective case control study to compare the effectiveness of cervical EBP for unclear leakage site and targeted EBP at leakage sites. Methodology: We reviewed the records of SIH patients who had undergone EBP at a single hospital. Patients were divided into Group CE (cervical EBP for unclear leakage site) and Group TE (targeted EBP at leakage site). the demographics, clinical characteristics, leakage site, EBP injection level, injected volume, and change in pain score (numeric rating scale [NRS]) were analysed for both groups. Results: We analysed 54 patients, with 13 and 41 patients in the CE and TE groups, respectively. EBP regions in the TE group included the cervical, thoracic, and lumbar regions. There were no significant differences in demographic data between the groups. The baseline NRS scores for headache were 7.8 ± 0.9 and 7.7 ± 0.8 (P = 0.771); scores after EBP were 2.9 ± 1.7 and 2.2 ± 1.1 (P = 0.195) in groups CE and TE, respectively. NRS changes of 4.9 ± 2.0 and 5.6 ± 1.5 (P = 0.348) occurred in groups CE and TE, respectively. The mean blood volume in the CE group was 10.4 ml. Clinical effectiveness did not differ significantly between the groups. Conclusion: Cervical EBP is as effective as targeted EBP when the CSF leakage site is unclear. Therefore, cervical EBP is appropriate for SIH in patients with unclear CSF leakage. Abbreviations: CSF - Cerebrospinal Fluid; EPB - Epidural Blood Patch; NRS - Numeric Rating Scale; SIH - Spontaneous Intracranial Hypotension Key words: Epidural Blood Patch; Spontaneous Intracranial Hypotension; Headache Citation: Ryu H, Lee HS, Kim H. Clinical effect of cervical vs. targeted epidural blood patch in spontaneous intracranial hypotension with unclear leakage sites. Anaesth. pain intensive care 2023;27(5):521−525; DOI: 10.35975/apic.v27i5.2307 Received: July 07, 2023; Reviewed: August 28, 2023; Accepted: September 01, 2023