title: A Small Leak Will Sink the Brain: Targeted C1-C2 Patching.
abstract: BACKGROUND
  Spontaneous intracranial hypotension syndrome results from spontaneous spinal cerebrospinal fluid (CSF) leaks. The first treatment of choice consists of lumbar epidural blood patching. If this fails, further imaging is mandatory to explore the possibility of targeted therapy.
  
  
  METHODS
  We describe a case of a 50-year-old woman who developed spontaneous intracranial hypotension after minor blunt cervical trauma, complicated with bilateral subdural hematomas. Two lumbar epidural blood patches were unsuccessful. Magnetic resonance imaging with intrathecal gadolinium revealed a CSF leak at the C1-C2 level. A targeted blood patch via a percutaneous high thoracic epidural approach was performed, and symptoms disappeared in the immediate postoperative period with a regression of the subdural hematomas on subsequent imaging.
  
  
  CONCLUSIONS
  A targeted epidural blood patch using an epidural catheter represents an elegant approach to a CSF leak at the C1-C2 region and can be successful in treating patients with severe intracranial hypotension syndrome.
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium. Electronic address: thomas.decramer@uzleuven.be.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decramer
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Belgium.
authors.forename: Pieter Jan
authors.initials: PJ
authors.lastname: Van Dyck-Lippens
authors.affiliation: Department of Neurology, University Hospitals Leuven, Belgium.
authors.forename: Tom P
authors.initials: TP
authors.lastname: Franken
authors.affiliation: Department of Radiology, University Hospitals Leuven, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demaerel
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium.
authors.forename: Johannes
authors.initials: J
authors.lastname: van Loon
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Theys
mesh_terms: D017217:Blood Patch, Epidural / Q000379:methods*; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy
keywords: CSF leak; Epidural blood patch; Spinal catheter; Spontaneous intracranial hypotension