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 and Methods: 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. {
Study Design: 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 (upperthoracic), 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.
Limitations: 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.
Key words: Central pain, cerebrospinal fluid leak, headache disorders, low intracranial pressure
syndrome, epidural blood patch, occipital headache
Clinical Features and Long-term Results of Spontaneous Intracranial Hypotension
