Treatment of Spontaneous Intracranial Hypotension Secondary to Sacral Perineural Cysts by Caudal Epidural Blood Patch-a Case Report

Abstract

Spontaneous intracranial hypotension (SIN), an uncommon reason of postural headache, is usually resulted from a spontaneous spinal cerebrospinal fluid (CSF) leak. However the mechanisms of the spontaneous CSF leak are unclear, and may be related to factors that cause dural sac weakness, such as sacral perineural cysts, the anatomical variations of the meninges in the lumbo-sacral region. In this report, we presented a female patient suffered from a postural headache. Sacral perineural cysts were noted according to her image study, and SIH was diagnosed. She was treated with the caudal epidural blood patch because of failed traditional treatments. We inserted a non-kinking catheter into the sacral epidural space under ultrasound-guidance and confirmed the location of catheter by the enhancement of contrast medium with fluoroscopy. After the treatment, the positional headache improved dramatically. In the discussion, we reviewed the clinical features, diagnosis, and managements of SIN and postural headache. We also discussed the possible pathophysiology of STH and mechanisms of the effect of epidural blood patch.