Assessing Epidural Blood Patch clinical outcome in Spontaneous Intracranial Hypotension: A multicenter study

Background and Purpose: Spontaneous Intracranial Hypotension (SIH) is characterized by reduced cerebrospinal fluid (CSF) pressure, typically resulting in orthostatic headaches and various neurologic symptoms which significantly impacts patients’ quality of life. This study aims to evaluate the efficacy of epidural blood patching (EBP) in alleviating symptoms of SIH and assesses patient overall satisfaction post-procedure. Methods: This multicenter retrospective study is based on a cohort of 52 SIH patients. After a screening process, 30 patients meeting the inclusion criteria were considered (mean age 46.8 years, 67% females). The study analyzed clinical records, the impact of headaches on daily living (HIT-6 score), and overall patient satisfaction (OS) post-EBP. Follow-up durations ranged from 6 to 36 months. Results: Among the 30 patients, 73% received non-targeted EBP, 13% targeted EBP, and 13% underwent both. The mean number of EBPs performed was 1.7. Follow-up revealed that one patient (3%) developed rebound intracranial hypertension, managed with acetazolamide. HIT-6 scores varied widely, with a median of 48, indicating a moderate impact on daily activities. Overall satisfaction median was 5 out of 10, with 33% reporting high satisfaction (OS ≥8). Despite EBP, 45% of patients experienced residual symptoms affecting their quality of life. Discussion: The demographic profile aligned with existing literature, showing a higher prevalence in females and a mean age of diagnosis in the mid-40s. The study highlights the variability in EBP efficacy, with many patients requiring multiple treatments and some experiencing persistent symptoms. Patient satisfaction was moderate, emphasizing the need for comprehensive management strategies that address both physiological and psychological aspects of SIH. Conclusions: EBP is a key treatment for SIH but demonstrates variable efficacy, necessitating individualized treatment plans and multidisciplinary approaches. Future research should focus on conducting long-term follow-up to enhance patient outcomes and quality of life.