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. 2020 Jan;16(1):1-8.
doi: 10.3988/jcn.2020.16.1.1.

Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

Hiroshi Kanno  1 , Tetsuya Yoshizumi  2 , Naomi Nakazato  3 , Masamichi Shinonaga  4
Affiliations

Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

Hiroshi Kanno et al. J Clin Neurol. 2020 Jan.

Abstract

Background and purpose: An epidural blood patch (EBP) is a highly effective therapy for spinal cerebrospinal fluid (CSF) leakage. However, the factors predicting the response to an EBP have not been fully elucidated. The aim of this study was to elucidate factors predicting the response to an EBP.

Methods: We retrospectively examined the relationship between the response to an EBP and clinical variables of 118 patients with spinal CSF leakage, such as patient age, sex, etiology, interval from the onset to EBP application, CSF opening pressure (OP), radioisotope (RI) cisternography findings, rate of RI remaining in the CSF space, computed tomography (CT) myelography findings, magnetic resonance imaging (MRI) findings, and subjective symptoms (headache, vertigo/dizziness, visual disturbance, nausea, numbness, nuchal pain, back pain/lumbago, fatigability, photophobia, and memory disturbance). The correlations between these variables and the responses to EBPs were analyzed statistically.

Results: A positive response to an EBP was significantly (p<0.05) correlated with the following variables: <1.5 years from the onset to EBP application, age <40 years, CSF OP <7 cm H₂O, epidural CSF leakage in RI cisternography, epidural CSF collection in MRI, <20% RI remaining after 24 hours, orthostatic headache, nausea, nuchal pain, and photophobia. The other variables did not show significant correlations with the responses to EBPs.

Conclusions: It might be prudent to take the following variables into account when applying an EBP to treat spinal CSF leakage: the interval from the onset to EBP application, age, CSF OP, epidural CSF leakage in RI, epidural CSF collection in MRI, rate of remaining RI, orthostatic headache, nuchal pain, photophobia, and nausea.

Keywords: cerebrospinal fluid volume depletion; epidural blood patch; predictor; spinal cerebrospinal fluid leakage.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Spine images in a patient with CSF leakage in and after EBP. A: X-ray photography to confirm the epidural infusion of contrast medium before applying an EBP. B: Sagittal CT image obtained after applying the EBP. Epidural blood mixed with contrast medium is evident from the thoracic sixth to the lumbar fifth vertebral levels. EBP: epidural blood patch.
Fig. 2
Fig. 2. Epidural CSF collection (arrows) in MRI fat-suppressed heavily T2-weighted images of patients with spinal CSF leakage. A: Upper cervical vertebral level. B: Lower cervical vertebral level. C: Lower lumber vertebral level.
Fig. 3
Fig. 3. Epidural CSF leakage (arrows) revealed by CT myelography. A: Epidural CSF leakage at the lower cervical vertebral level. B: Epidural CSF leakage at the upper thoracic vertebral level. C: Epidural CSF leakage at the lumbar vertebral level.
Fig. 4
Fig. 4. RI images of patiests with CSF leakage. A: Epidural CSF leakage at the lumbar vertebral level in RI cisternography. B: Epidural CSF leakage at the upper cervical vertebral level in coronal (upper) and axial (lower) SPECT images. C: Epidural CSF leakage at the upper lumbar vertebral level in coronal (upper) and axial (lower) on SPECT images. Leak points of CSF (arrows, A–C). RI: radioisotope.
See this image and copyright information in PMC

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