Large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for treatment of spontaneous intracranial hypotension.
OBJECTIVE
Spontaneous intracranial hypotension can be a therapeutic challenge to the treating physician. In this study, we present our experience with the administration of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site.


METHODS
A retrospective review was conducted of patients with spontaneous intracranial hypotension who underwent a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site from 2010 to 2012. Patient demographic data, clinical charts, indications for treatment, radiographic images, procedure notes, and postprocedure hospital course were reviewed.


RESULTS
Overall, 9 patients were identified who underwent 20 blood patch procedures. Patients were selected to undergo the large-volume procedure either because they had a failed site-directed epidural blood patch or if imaging demonstrated multiple possible leak sites. There were 6 women and 3 men, with an average age of 33.5 years. The mean volume of blood injected per procedure was 54.1 mL (median=55 mL; range=38-70 mL). All patients had an orthostatic headache as one of their presenting symptoms; 22% also presented with neurocognitive decline and behavioral changes; 89% of patients had improvement or resolution of their symptoms; and 80% of patients who had a previously failed site-directed epidural blood or fibrin glue patch improved with a large volume catheter-directed blood patch.


CONCLUSIONS
Our experience supports the use of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for the treatment of spontaneous intracranial hypotension. Additionally, our results indicate a role for this procedure in refractory cases of spontaneous intracranial hypotension.
From the Departments of Radiology (J.G., J.J.G., N.C.).
J
J
Griauzde
From the Departments of Radiology (J.G., J.J.G., N.C.) Neurosurgery (J.J.G., N.C., T.J.W., A.S.P.) Otolaryngology (J.J.G.), University of Michigan Hospitals, Ann Arbor, Michigan. gemmete@med.umich.edu.
J J
JJ
Gemmete
From the Departments of Radiology (J.G., J.J.G., N.C.) Neurosurgery (J.J.G., N.C., T.J.W., A.S.P.).
N
N
Chaudhary
Neurosurgery (J.J.G., N.C., T.J.W., A.S.P.).
T J
TJ
Wilson
Neurosurgery (J.J.G., N.C., T.J.W., A.S.P.).
A S
AS
Pandey
D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D005260:Female; D006261:Headache / Q000628:therapy; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult