Targeted Versus NonTargeted Epidural Blood Patch for Spontaneous Intracranial Hypotension: A Systematic Review and Meta-Analysis

Abstract

Background: Spontaneous intracranial hypotension (SIH) is characterized by CSF leakage leading to orthostatic headaches and neurological deficits. In some cases, it can be extremely severe to cause nausea, vomiting, and vertigo. Despite conservative treatment, epidural blood patch remains the optimal approach for empiric resolution of symptoms. However, the medical community lacks consensus regarding the best approach to use: targeted epidural blood patch (TEBP) versus nontargeted epidural blood patch (NTEBP). Methods: A systematic review and metanalysis was conducted on multiple databases with a two-step selection process in order to exclude studies with insufficient data, irrelevance, and lack of comparative analysis between the two procedures. From the included studies, we comparatively analyzed overall good outcomes, success at first attempts, and relapse rates between the groups of study. Results: We included seven studies matching our inclusion criteria. No significant difference was noted between the TEBP and NTEBP groups concerning the improved overall outcome and success at first attempt. Similarly, comparable statistical significance was noted concerning the relapse rates. Conclusion: TEBP and NTEBP are both effective treatments for SIH. However, given the lack of statistical difference between the interventions, along with considerations such as the patient risk profiles, physician expertise, and avoidance of invasive imaging procedures, the analysis suggests that NTEBP may be considered a viable initial approach, regardless of the identification of the leak.