Evaluation and management of spontaneous intracranial hypotension if repeated lumbar epidural blood patches are unsuccessful

CSF: cerebrospinal fluid; CT: computed tomography; MR: magnetic resonance.

* Refer to the UpToDate topic and algorithm on the initial management of spontaneous intracranial hypotension for details on the initial management of patients with spontaneous intracranial hypotension.

¶ Digital subtraction myelography in the lateral decubitus or prone positioning may be performed for patients with suspected CSF leak due to a dural tear on the ventral surface of the spinal canal or those with a suspected CSF-venous fistula.

Δ Surgical repair or endovascular treatment may be applicable for some patients with a CSF leak unlikely to respond to a targeted blood patch, such as patients with intracranial hypotension due to CSF-venous fistula.

◊ Repeat targeted epidural blood patch may be attempted if surgical or interventional repair is not possible or unsuccessful.