title: A wearable epidural catheter infusion system for patients with intractable spontaneous intracranial hypotension.
abstract: OBJECTIVE
  Spontaneous intracranial hypotension is an important cause of secondary headaches, and most patients respond well to epidural blood patching or direct repair of the underlying spinal cerebrospinal fluid leak. However, options are limited for those patients who have exhausted these traditional treatments, especially when spinal imaging is normal. We describe a wearable epidural catheter infusion system for patients with intractable spontaneous intracranial hypotension.
  
  
  METHODS
  Six patients with intractable spontaneous intracranial hypotension (4 women and 2 men; mean age, 53 years; mean duration of symptoms, 50 months) underwent placement of a permanent indwelling spinal epidural catheter attached to an external infusion pump. The Migraine Disability Assessment questionnaire was used to assess the severity of the symptoms, before and during treatment.
  
  
  RESULTS
  The infusion resulted in complete or near-complete symptom relief in 5 of 6 patients (Migraine Disability Assessment score decreased from grade IV to grade I or II). However, the epidural catheter infusion system was removed in 2 patients because of infection, in 1 patient because of delayed failure to provide adequate symptom control, and in 1 patient because of minimal symptom relief. Two patients reported excellent and sustained symptom relief over 27 and 36 months of follow-up.
  
  
  CONCLUSIONS
  This wearable epidural catheter infusion system showed promising efficacy results but the high rate of complications limits its use to a very select group of patients.
authors.affiliation: From the Departments of *Neurosurgery and †Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Wouter I
authors.initials: WI
authors.lastname: Schievink
authors.forename: Howard L
authors.initials: HL
authors.lastname: Rosner
authors.forename: Charles
authors.initials: C
authors.lastname: Louy
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged