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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Comparison of the outcome between epidural blood patching (EBP) and epidural air and saline Injection (EASI) treatment for chronic post-traumatic headache

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  • Kiyoshi Takagi - Department of Neurosurgery, Chiba-Kashiwa Tanaka Hospital
  • Kazuyoshi Kato - Department of Surgery, Kitatama hospital
  • Yoko Kato - Department of Neurosurgery, Fujita Health University

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 054

doi: 10.3205/13dgnc471, urn:nbn:de:0183-13dgnc4718

Published: May 21, 2013

© 2013 Takagi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Chronic post-traumatic headache (CPTH) and mild traumatic brain injury (mTBI) are still common complication of minor injuries and effective treatment has not yet been established. I have reported that epidural blood patching (EBP) may be effective for CPTH (Eur J Med Res 12; 249, 2007). However, the effect was limited. Before the era of MRI, air epidulography was performed and it was used as a treatment for lumbago (Zentralbl Gynakol 300; 75, 1953). Based upon this report, we have developed epidural air and saline injection (EASI) treatment. The purpose of this paper is to compare the outcome of EBP and EASI.

Method: Two hundred and eighty-five cases with CPTH were the candidates for EBP or EASI. All of them also had other life-disturbing symptoms such as vertigo, blurred vision, and concentration disturbance. They had been treated in vain for over 3 months. Neuroimaging studies such as MRI did not show responsible lesions. EBP was performed in lateral recumbent position and EASI in sitting position at lumbar level. The effectiveness was evaluated 3 months after the treatments subjectively in 6 categories; Complete cure (CC; return to normal life without headache), Excellent (E; return to normal life with diminished residual headache), Good (G; diminished symptoms but still disturbed normal life), Fair (F; diminished symptoms with recurrence), No (N; no effectiveness), and Poor (P; worsened). Results were shown in mean ± SD. Statistic analysis was performed by Chi-square method and significant level was set at p value less than 0.05.

Results: Two hundred and twenty-two cases received only EBP (mean age was 38.4 ± 11.7 yo) and 63 cases received only EASI (mean age was 38.7 ± 14.9 yo). The outcome for EBP was as follows: CC = 36 cases (16.2%), E = 92 cases (41.4%), G = 59 cases (26.6%), F = 35 cases (15.8%). The outcome for EASI was as follows: CC = 22 cases (34.9%), E = 25 cases (39.7%), G = 13 cases (20.6%), F = 3 cases (4.8%). No patients worsened 3 months after both treatments. Cases with the outcome of CC + E and G + F were 128 cases (57.6%) and 94 cases (42.3%) for EBP and 47 cases (74.6%) and 16 cases (25.4%) for EASI respectively. The outcome of EASI was significantly better than that of EBP (p = 0.0148).

Conclusions: Although EBP and EASI are both effective for CPTH, EASI is significantly better than EBP. Epidural air and oxygen injection treatment can be a safe and effective treatment for long lasting CPTH and/or mTBI.