• Chieh-Min Hsu, Yu-Cheng Liu, Ying-Chu Chen, Jong-Ling Fuh, Hui-Chun Huang, Yen-Feng Wang, I-Ying Chiang, and Yeong-Ray Wen.
• Department of Anesthesiology, Pain Management and Research Center, China Medical University Hospital, Taichung, Taiwan.
• Pain Pract. 2022 Jul 1; 22 (6): 586-591.

BackgroundEpidural blood patch (EBP) is a generally effective treatment for spontaneous intracranial hypotension (SIH) caused by cerebrospinal fluid (CSF) leakage through the spinal dura mater. It is still unclear; however, whether application near the leakage site (targeted EBP) is more effective than distal application (untargeted EBP). Further, EBP targeted to high thoracic or cervical spine levels is infrequent due to greater technical requirements and potential complications. Here, we examined the safety and efficacy of EBP applied to high thoracic or cervical spine levels.MethodsWe retrospectively reviewed the clinical and outcome data of 13 patients receiving cervical or high thoracic EBP for SIH. All patients were referred by neurologists following poor response to conservative treatment and presented with persistent headache aggravated by orthostatic changes.ResultsNeuroimaging confirmed CSF leakage and targeted EBP resulted in immediate pain improvement. Repeated injections provided additional improvement for patients with recurrent headache. No serious adverse events were documented during follow-up.ConclusionBased on recent studies and our clinical experience, we conclude that EBP targeted to the high thoracic and cervical spine is safe and effective for early-stage SIH.© 2022 World Institute of Pain.

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