Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 8, 3010, Bern, Switzerland.
Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Clin Neuroradiol. 2023 Mar;33(1):211-218. doi: 10.1007/s00062-022-01205-7. Epub 2022 Aug 26.
Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spinal CSF leaks in SIH patients after non-targeted EBP.
Patients with SIH and a confirmed spinal CSF leak who had been treated with non-targeted EBP were retrospectively analyzed. Primary outcome was persistence of CSF leak on spine MRI or intraoperatively. Secondary outcome was change in clinical symptoms after EBP.
In this study 51 SIH patients (mean age, 47 ± 13 years; 33/51, 65% female) treated with non-targeted EBP (mean, 1.3 EBPs per person; range, 1-4) were analyzed. Overall, 36/51 (71%) patients had a persistent spinal CSF leak after EBP on postinterventional imaging and/or intraoperatively. In a best-case scenario accounting for missing data, the success rate of sealing a spinal CSF leak with an EBP was 29%. Complete or substantial symptom improvement in the short term was reported in 45/51 (88%), and in the long term in 17/51 (33%) patients.
Non-targeted EBP is an effective symptomatic treatment providing short-term relief in a substantial number of SIH patients; however, successful sealing of the underlying spinal CSF leak by EBP is rare, which might explain the high rate of delayed symptom recurrence. The potentially irreversible and severe morbidity associated with long-standing intracranial hypotension supports permanent closure of the leak.
硬膜外血贴（EBP）是治疗自发性颅内低血压（SIH）的一种微创治疗方法。EBP 后的随访主要依赖于临床表现，缺乏成功封闭潜在脊柱脑脊液（CSF）漏的证据。我们的目的是评估非靶向 EBP 后 SIH 患者脊柱 CSF 漏成功封闭的比率。
回顾性分析了接受非靶向 EBP 治疗的 SIH 患者和证实存在脊柱 CSF 漏的患者。主要结局是脊柱 MRI 或手术中 CSF 漏是否持续存在。次要结局是 EBP 后临床症状的变化。
在这项研究中，分析了 51 例接受非靶向 EBP（每人平均 1.3 次 EBP；范围 1-4 次）治疗的 SIH 患者（平均年龄 47±13 岁；33/51，65%为女性）。总体而言，36/51（71%）例患者 EBP 后影像学和/或手术中存在脊柱 CSF 漏持续存在。在考虑缺失数据的最佳情况下，EBP 封闭脊柱 CSF 漏的成功率为 29%。45/51（88%）例患者在短期报告完全或大部分症状改善，17/51（33%）例患者在长期报告症状改善。
非靶向 EBP 是一种有效的对症治疗方法，可为大多数 SIH 患者提供短期缓解；然而，EBP 成功封闭潜在的脊柱 CSF 漏的情况很少见，这可能解释了症状复发率高的原因。长期颅内低血压相关的潜在不可逆和严重发病率支持永久性封闭漏口。
