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Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension
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  • Published on: 14 September 2023
    Epidural blood patch for spontaneous intracranial hypotension: Comments to the published guideline
    • Kamath Sriganesh, Neuroanesthesiologist and Consultant, NIMHANS Pain Management Clinic National Institute of Mental Health and Neurosciences, Bengaluru, India
    • Other Contributors:
      • Jitender Saini, Neuroradiologist

    Dear Editor-in-Chief,
    We read with great interest the consensus guidelines for diagnosis and management of spontaneous intracranial hypotension (SIH). [1] In the absence of any recommendations, this guideline will help clinicians in formulating their diagnostic and management approaches for SIH. In this letter, we wish to discuss about the epidural blood patch (EBP) in the management of SIH. The role of targeted EBP for management of SIH has not been compared with non-targeted EBP in randomized controlled trials to establish superiority of one over the other. A recent systematic review of studies with 10 or more patients with SIH reported similar success with either technique. [2] However, where expertise is available and when the precise site of cerebrospinal fluid (CSF) leak is identifiable, it is prudent to consider targeted EBP as the first choice. This reduces the volume of autologous blood required, minimizes the need of reliance on gravity for spread of epidurally placed blood to the potential site of leak and decreases the procedure failure rates and need for subsequent EBPs or surgical interventions. In our center, which is a tertiary care neurosciences academic hospital, after an initial conservative management for a week, a targeted EBP is performed as the preferred approach to manage SIH. [3] If the site of leak is not determinable and if the expertise to perform cervical or thoracic EBP is not available, a non-targeted EBP may be the preferred interventi...

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    Conflict of Interest:
    None declared.