Image-Guided Interventional Therapy
CT-Guided Epidural Blood Patch: Precisely Targeting Spontaneous Intracranial Hypotension
Update Date：2024/09/05，
Views：113
Have you ever experienced waking up with a splitting headache that miraculously eases when you lie down, only to return with full force the moment you stand up? This could be due to spontaneous intracranial hypotension (SIH), a condition that causes low-pressure headaches. This lesser-known cause of chronic headaches affects many, leaving them seeking answers and relief, often without success. Let’s delve into this condition and explore its powerful treatment: the epidural blood patch.
Our brain is enveloped by a layer of clear cerebrospinal fluid (CSF) and surrounded by the dura mater. Under normal circumstances, these act as a protective shield for the brain and spinal cord, safeguarding the central nervous system from external impacts while also serving as a suspension and support system. But what happens when this protective "armor" becomes damaged?
When the dura mater, which encases the cerebrospinal fluid, develops a defect, the CSF can gradually leak through these openings. Without the necessary support, the brain begins to sag, triggering a range of symptoms. The most characteristic of these is positional headache: patients experience severe headaches when upright, which ease somewhat when lying down. Additionally, patients may also suffer from neck stiffness, tinnitus, hearing changes, nausea, and dizziness.
Diagnosing spontaneous intracranial hypotension is a challenging task. It requires an experienced physician to combine a thorough medical history with detailed neurological examinations and brain MRI scans. Sometimes, a lumbar puncture is necessary to directly measure CSF pressure. If SIH is suspected, more advanced imaging, such as MR myelography, may be needed to pinpoint the exact location of the CSF leak. The process is much like a detective solving a case—unraveling clues and delving deeper layer by layer.
Now, let's discuss the powerful treatment for spontaneous intracranial hypotension: the epidural blood patch. The principle behind this treatment is actually quite straightforward. A physician draws a small amount of blood from the patient (approximately 15 to 30 milliliters) and injects it into the epidural space of the spine. Once injected, the blood coagulates and forms a natural "patch."
This patch serves a dual purpose:
1. Immediate Pressure Increase: The pressure in the epidural space is immediately elevated, reducing the leakage of cerebrospinal fluid.
2. Sealing the Defect: The blood clot gradually seals the defect in the dura mater, allowing the cerebrospinal fluid to reaccumulate and restore normal pressure.
However, while the concept is straightforward, the execution is challenging. The epidural space is very small, and accurately injecting blood into the precise location of the dura mater defect is akin to hitting a distant target with your eyes closed. Advances in imaging technology have provided a breakthrough in this technical challenge: CT-guided targeted epidural blood patching allows physicians to perform the procedure with the precision of a marksman, accurately treating the site of the dura mater defect.
xperienced interventional radiologists can use CT guidance to precisely locate the defect in the dura mater. By mixing contrast agents with the patient's own blood, they can inject this "blood patch" into the epidural space, which is only 2-3 centimeters deep, to accurately fill the defect. This technique is akin to a marksman making a perfect shot, allowing for precise targeting of the defect.
Most patients experience noticeable improvement within 24 to 48 hours after receiving the treatment, though some may require multiple sessions to fully resolve the issue. After the procedure, patients typically need to lie flat for a few hours and should avoid strenuous exercise and heavy physical activities for several days. Overall, the success rate of the treatment is as high as 80-90%.
As spontaneous intracranial hypotension becomes more widely recognized, many patients who have long suffered from unexplained chronic headaches finally have a reasonable explanation for their condition. Fortunately, with the advent of high-precision CT-guided epidural blood patching, these patients, who have endured chronic pain, now have an effective treatment option.
If you are experiencing similar issues, it’s worth discussing them in detail with your physician. Sometimes, the solution to persistent headaches might be just a "needle" away.
Dr. Chang Kai-Hsiang from the Department of Radiology