Three Fluoroscopy-Guided Epidural Blood Patches for the Management of Spontaneous Intracranial Hypotension

This report describes the use of three fluoroscopy-guided epidural blood patch procedures to treat a patient with spontaneous intracranial hypotension. A 42-year-old woman with no history of history of surgery or trauma presented with headache and dizziness. Magnetic resonance imaging revealed an extradural cerebrospinal fluid leak collection leading to a diagnosis of spontaneous intracranial hypotension. Common symptoms of spontaneous intracranial hypotension include orthostatic headache, nausea, neck pain, hearing disturbance, dizziness, and aural fullness. However, the cause of spontaneous intracranial hypotension in this patient was not clear. Conservative therapy as the first treatment for spontaneous intracranial hypotension failed to alleviate the patient's symptoms. Subsequently, the anesthetist performed fluoroscopy-guided preoperative epidural catheterization in the prone position thrice. After the symptomatic improvement, the patient was discharged on the 118 day after admission. Although the treatment with an epidural blood patch became the standard of care in Japan from 2016, the fluoroscopy-guided method has not been generalized yet. Our report suggests that the fluoroscopy-guided approach for the epidural blood patch in the prone position is safe and reliable.