Kong Cunlong, Liu Zuying, Fu Lijun, Bu Huilian, Li Xinxin, Liu Wenjie, Ma Zhonghua, Wang Xiao, Yuan Jingjing, Liu Qingying, Fan Xiaochong, Zhang Wei
Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Neurosurg Rev. 2025 Mar 14;48(1):298. doi: 10.1007/s10143-025-03455-8.
Spontaneous intracranial hypotension (SIH) is a rare clinical condition that may occur due to cerebrospinal fluid leakage. The purpose of this study was to compare the safety and efficacy of single catheter multisite epidural blood patch(CA-EBP) with standard procedures, including blinded and targeted epidural blood patch (EBP) for the treatment of SIH, and to investigate the effectiveness of dexamethasone as an adjuvant. Clinical data of 68 patients with postoperative SIH who underwent EBP between March 2022 and May 2024. In this prospective cohort trial, 68 patients were allocated to four groups: blind EBP, targeted EBP, CA-EBP, and CA-EBP + dexamethasone, based on the procedure received. Patients were assessed for pain using the visual analog scale (VAS), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and quality of life using the Headache lmpact Test (HIT-6). Adverse events were documented to evaluate the safety of the procedure. A total of 68 patients were recruited for the study, comprising 41 females and 27 males, with a mean age of 40.76 years. The participants were distributed as follows: 9 in the blind EBP group, 17 in the targeted EBP group, 20 in the CA-EBP group, and 22 in the CA-EBP + dexamethasone group. After a single treatment, the severity of headaches significantly decreased in 5 (55.56%) patients in the blinded EBP group, 13 (76.47%) patients in the targeted EBP group, 19 (95.00%) patients in the CA-EBP group, and 20 (90.91%) patients in the CA-EBP + dexamethasone group. The most frequent complications in both groups were transient intracranial hypertension; however, no serious complications were reported. CA-EBP stands out as a safe and effective therapy for SIH. It notably alleviates pain, enhances quality of life, and surpasses standard EBP procedures. Moreover, dexamethasone, when used as an adjunct, proves effective in mitigating postoperative complications.
自发性颅内低压（SIH）是一种罕见的临床病症，可能由于脑脊液漏出而发生。本研究的目的是比较单导管多部位硬膜外血贴（CA-EBP）与标准程序（包括盲法和靶向硬膜外血贴（EBP））治疗SIH的安全性和有效性，并研究地塞米松作为辅助药物的有效性。收集了2022年3月至2024年5月期间接受EBP治疗的68例术后SIH患者的临床资料。在这项前瞻性队列试验中，根据接受的治疗程序，将68例患者分为四组：盲法EBP组、靶向EBP组、CA-EBP组和CA-EBP+地塞米松组。使用视觉模拟量表（VAS）评估患者的疼痛程度，使用医院焦虑抑郁量表（HADS）评估焦虑和抑郁情况，使用头痛影响测试（HIT-6）评估生活质量。记录不良事件以评估治疗程序的安全性。共招募了68例患者参与研究，其中女性41例，男性27例，平均年龄40.76岁。参与者分布如下：盲法EBP组9例，靶向EBP组17例，CA-EBP组20例，CA-EBP+地塞米松组22例。单次治疗后，盲法EBP组5例（55.56%）患者的头痛严重程度显著降低，靶向EBP组13例（76.47%）患者，CA-EBP组19例（95.00%）患者，CA-EBP+地塞米松组20例（90.91%）患者。两组中最常见的并发症是短暂性颅内高压；然而，未报告严重并发症。CA-EBP是一种安全有效的SIH治疗方法。它能显著减轻疼痛，提高生活质量，优于标准的EBP程序。此外，地塞米松作为辅助药物，在减轻术后并发症方面被证明是有效的。
