title: Thoracic Epidural Blood Patches in the Treatment of Spontaneous Intracranial Hypotension: A Retrospective Case Series.
abstract: BACKGROUND
  Spontaneous intracranial hypotension (SIH) results from leaks developing in the dura mater. The major symptom is orthostatic headache which gradually disappears after lying down. Lumbar epidural blood patches (EBPs) can be effective in relieving headaches, however, thoracic and cervical EBPs have also been applied to alleviate the symptoms.
  
  
  OBJECTIVE
  Retrospective collection of the main characteristics of SIH, site and amount of blood injection, and clinical outcomes of 18 patients who underwent thoracic EBPs for intractable SIH.
  
  
  METHODS
  Retrospective case series
  
  
  RESULTS
  All thoracic autologous EBPs except 3 were performed in the sitting position. Patients undergoing epidural puncture at lower thoracic levels (T10-T12) received 25 mL of autologous blood, 15 mL and 18 mL were injected at spinal segments T5-T7 (mid-thoracic) and T2-T4 (upper- thoracic), respectively. Thoracic EBPs did not lead to immediate resolution of symptoms in 3 of 18 patients; one of them underwent early repetition with complete headache relief, one refused a second EBP, and one experienced partial resolution, followed by a recurrence, and then satisfactory improvement with a second high thoracic EBP. In long-term follow-up only 2 patients complained of symptoms or relapses.
  
  
  CONCLUSIONS
  Retrospective nature of the case series, single center experience.
  
  
  CONCLUSIONS
  Performing thoracic-targeted EBPs as the preferred approach theoretically improves results with respect to those observed with lumbar EBPs. The immediate response was comparable with that of other reports, but the long-term success rate (90%) turned out to be very effective in terms of both quality of headache relief and very low incidence of recurrence.
authors.affiliation: Department of Medicine UO Anaesthesia and Intensive, Care, Padua University Hospital Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Helmut
authors.initials: H
authors.lastname: Galligioni
authors.forename: Stefania
authors.initials: S
authors.lastname: Barbieri
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D004824:Epidural Space; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013904:Thoracic Vertebrae; D016896:Treatment Outcome