Abstract
Cerebrospinal fluid hypovolemia (CFH) is caused by reduced cerebrospinal fluid (CSF) volume. CFH is characterized clinically by orthostatic headache. Although epidural blood patch (EBP) is widely done for the treatment of CFH, epidural physiologic saline injection (EPI) is recommended for diagnosis of CFH. We report the results of EPI with contrast medium under fluoroscopic guidance for the treatment of 10 patients with CFH (post-traumatic, n=8; spontaneous, n=1; and post-spinal, n=1). The duration of symptoms and signs in these patients ranged from 2 months to 30 years. Six patients had received EBP before our treatment. Radioisotope cisternography detected CSF leakage in 3 patients, and early accumulation of radioisotope in the urinary bladder in 5 patients. Orthostatic headache and auditory and vestibular symptoms improved in all patients after EPI. Seven patients received single EPI, and 3 patients required two injections. We conclude that EPI is effective for selected CFH patients who still have symptoms and signs of CFH despite conservative therapy.
