• Thomas Decramer, Pieter Jan Van Dyck-Lippens, Tom P Franken, Philippe Demaerel, Johannes van Loon, and Tom Theys.
• Department of Neurosurgery, University Hospitals Leuven, Belgium; Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Belgium. Electronic address: thomas.decramer@uzleuven.be.
• World Neurosurg. 2017 May 1; 101: 816.e1-816.e3.

BackgroundSpontaneous 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.Case DescriptionWe 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.ConclusionsA 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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