Comparison of the Efficacy of Epidural Autologous Blood Patch in the Treatment of Spontaneous Intracranial Hypotension and Post-Dural Puncture Headache

Sung Hyun Yoon; Joon Woo Lee; Geun Young Lee; Eugene Lee; Heung Sik Kang

doi:10.3348/jksr.2014.70.4.299

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Yoon, Lee, Lee, Lee, and Kang: Comparison of the Efficacy of Epidural Autologous Blood Patch in the Treatment of Spontaneous Intracranial Hypotension and Post-Dural Puncture Headache

Musculoskeletal Radiology

Journal of the Korean Society of Radiology 2014; 70(4): 299-305.

Published online: 9 April 2014

DOI: https://doi.org/10.3348/jksr.2014.70.4.299

Comparison of the Efficacy of Epidural Autologous Blood Patch in the Treatment of Spontaneous Intracranial Hypotension and Post-Dural Puncture Headache

Sung Hyun Yoon, MD, Joon Woo Lee, MD, Geun Young Lee, MD, Eugene Lee, MD, Heung Sik Kang, MD

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

Corresponding author: Geun Young Lee, MD. Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel. 82-31-787-7609, Fax. 82-31-787-4011, netty0523@gmail.com

Received 15 December 2013 Accepted 14 February 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH).

Materials and Methods

Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05).

Results

In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief.

Conclusion

Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

Keywords: Blood Patch, Epidural, Post-Dural Puncture Headache, Intracranial Hypotension

Figures and Tables

Fig. 1

A 30-year-old male patient who was diagnosed as spontaneous intracranial hypotension. Postmyelography CT revealing extradural spreading of contrast medium around the right nerve root C7 (open arrow) and anterior epidural space at the C7/T1 level (arrow).

Fig. 2

A 38-year-old male patient who was diagnosed as spontaneous intracranial hypotension. Extradural contrast medium leakage was seen at multilevel. Epidural blood patch was done at L3/4 where extradural spreading of contrast medium was extensive.

A. Postmyelography CT revealing extradural spreading of contrast medium in the epidural space at the L3/4 level and extension to outside of the spinal canal (arrows).

B. Postmyelography CT revealing extradural spreading of contrast medium in the epidural space at the L4/5 level (arrow) and around the left nerve root L4 (open arrow).

C. Postmyelography CT revealing extradural spreading of contrast medium (arrow) in the anterior epidural space at the L5/S1 level.

Table 1

Initial EBP in SIH and PDPH

Note.-CR = complete relief, CSF = cerebrospinal fluid, EBP = epidural blood patch, IR = incomplete relief, PDPH = post-dural puncture headache, SIH = spontaneous intracranial hypotension

Table 2

Initial Response of Epidural Blood Patch

Table 3

EBP in Patients with Recurred Postural Headache

Note.-CSF = cerebrospinal fluid, EBP = epidural blood patch, IR = incomplete relief, PDPH = post-dural puncture headache

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