Outcomes of CT-Guided Targeted Epidural Patching for Lateral Dural Tears in Spontaneous Intracranial Hypotension: A Multicenter Retrospective Cohort Study.

BACKGROUND AND PURPOSE: Spontaneous intracranial hypotension (SIH) due to lateral dural tears with spinal longitudinal extradural fluid collections (SLECs) can cause disabling orthostatic headaches. While epidural patching is commonly used as first-line treatment, outcomes specific to lateral dural tears have not been well-characterized. We aimed to evaluate clinical and radiologic outcomes following CT-guided patching for lateral dural tears and assess whether anatomic or procedural factors-including the presence of a herniated arachnoid pouch, patch volume, material, or approach-influence treatment success.

MATERIALS AND

METHODS

This was a retrospective multicenter cohort study of patients with lateral dural tears treated with CT-guided epidural patching between December 2013 and March 2025. Demographics, leak characteristics, patching details, and clinical and imaging outcomes were collected. The presence of herniated arachnoid pouches on spine MRI and pre-/posttreatment Bern scores were recorded. Associations among clinical resolution, SLEC resolution, and procedural variables were analyzed using univariate methods.

RESULTS

Fifty-six patients (mean age, 38.7 [SD, 11.7] years; 80% female) were included. Mean pretreatment Bern score was 6.6 (SD, 2.3); no patients had superficial siderosis. Clinical resolution occurred in 20/56 (35.7%), and SLEC resolution occurred in 10/40 (25%) on postpatch spine MRI. A herniated arachnoid pouch was present in 69.7% and was associated with lower SLEC resolution (30% versus 80%, P =.003). Patch type, volume, transforaminal approach, and needle placement into the herniated pouch were not associated with outcomes. Postpatch Bern scores were lower among those with clinical resolution (0.9 [SD, 1.1] versus 2.6 [SD, 2.5]; P = .046). Of 11 patients with complete clinical improvement who had postpatch spine MRI, 5 (45.5%) had persistent SLECs.

CONCLUSIONS

CT-guided patching led to complete symptom resolution in roughly one-third of patients with lateral dural tears. Herniated arachnoid pouch predicted lower SLEC resolution, while procedural variables were not predictive of outcome. A subset of patients improved clinically despite persistent extradural fluid, emphasizing the need for long-term monitoring.