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A systematic review and meta-analysis of factors affecting the outcome of the epidural blood patching in spontaneous intracranial hypotension

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Abstract

Spontaneous intracranial hypotension (SIH) is an often misdiagnosed condition resulting from non-iatrogenic cerebrospinal fluid (CSF) hypovolemia, typically secondary to spinal CSF leakage. Patients commonly present with posture-related headache, nausea, and vomiting. Following failure of conservative measures, epidural blood patching (EBP) is the most commonly performed intervention for spinal CSF leaks. The authors performed a systematic review and meta-analysis of existing literature to evaluate the role of different factors possibly affecting the efficacy of the EBP procedure. In accordance with the PRISMA guidelines, PubMed/Medline and SCOPUS databases were searched. Six eligible articles were retrieved. Five hundred patients were treated for SIH with EBP, of which 300 reported good response defined as complete remission of symptoms within 48 h after the first EBP requiring no further invasive treatment. Among the factors available for meta-analysis, none was found to be statistically significant in affecting the efficacy of the EBP procedure. A largely symmetrical funnel plot is reported for all the variables evaluated, indicating that publication bias did not play a significant role in the observed effects. The current knowledge about SIH and the EBP is scarce. The existing literature is contradictory and insufficient to aid in clinical practice. More studies are needed to draw significant conclusions that may help in the identification of patients at higher risk of EBP failure, who may benefit from different approaches.

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Author notes

  1. Francesco Signorelli and Valerio M. Caccavella contributed equally to the work

Authors and Affiliations

  1. Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Francesco Signorelli, Valerio M. Caccavella, Martina Giordano, Filippo Maria Polli, Alessandro Olivi & Nicola Montano

  2. Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Eleonora Ioannoni & Anselmo Caricato

  3. Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy

    Alessandro Olivi & Nicola Montano

Authors
  1. Francesco Signorelli
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  2. Valerio M. Caccavella
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  3. Martina Giordano
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  4. Eleonora Ioannoni
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  6. Filippo Maria Polli
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  7. Alessandro Olivi
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  8. Nicola Montano
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Contributions

Each of the authors contributed substantially to the creation of this manuscript. Study conception and design: N.M., F.S., A.O. Acquisition of data: M.G., V.M.C., E.I. Analysis and interpretation of data: N.M., V.M.C., F.S., F.M.P. Drafting of manuscript: M.G., N.M., V.M.C., F.S. Critical revision: E.I., A.O., A.C., F.M.P

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Correspondence to Valerio M. Caccavella.

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Signorelli, F., Caccavella, V.M., Giordano, M. et al. A systematic review and meta-analysis of factors affecting the outcome of the epidural blood patching in spontaneous intracranial hypotension. Neurosurg Rev 44, 3079–3085 (2021). https://doi.org/10.1007/s10143-021-01505-5

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  • DOI: https://doi.org/10.1007/s10143-021-01505-5

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