title: Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacies and compare the outcomes of targeted and blind epidural blood patch (EBP) treatments of spontaneous intracranial hypotension (SIH).
  
  
  METHODS
  Between January 1999 and December 2009, 56 patients who were diagnosed with SIH received either a targeted or blind EBP. The efficacies of targeted and blind EBPs were evaluated based on degree and duration of symptom relief and on the need for repeat EBP.
  
  
  RESULTS
  Fifty-six patients (23 men and 33 women; mean age, 39.6 years; age range, 22-69 years) were included in this study. Thirty-one patients received EBP that targeted CSF leak segments, and 25 received a blind EBP because primary CSF leak sites were not identified (19 patients via a lumbar epidural route, mainly the L 3-4 level, regardless of primary CSF leak site, and 6 patients via upper thoracic epidural spaces, mainly the T4-6 level). In the 31 patients who received a targeted EBP, 27 (87.1%) exhibited clinical improvement after first administration. In contrast, 13 of the 25 patients (52%) who received a blind EBP via a lumbar or upper thoracic epidural route achieved complete recovery. Targeted EBPs were more effective than blind EBPs for the treatment of SIH (p < 0.05).
  
  
  CONCLUSIONS
  EBPs targeting CSF leaks can be safely placed under fluoroscopic guidance in patients with SIH and are more likely to be effective than blindly placed EBPs.
authors: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea.
authors: K-I
authors: KI
authors: Cho
authors: H-S
authors: HS
authors: Moon
authors: H-J
authors: HJ
authors: Jeon
authors: K
authors: K
authors: Park
authors: D-S
authors: DS
authors: Kong
mesh_terms: D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D019585:Intracranial Hypotension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult