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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleSpine Imaging and Spine Image-Guided Interventions

Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map

T.J. Amrhein, J.W. Williams, L. Gray, M.D. Malinzak, S. Cantrell, C.R. Deline, C.M. Carr, D.K. Kim, K.M. Goldstein and P.G. Kranz
American Journal of Neuroradiology May 2023, DOI: https://doi.org/10.3174/ajnr.A7880
T.J. Amrhein
aFrom the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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J.W. Williams Jr
bDivision of General Internal Medicine (J.W.W., K.M.G.)
dDurham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
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L. Gray
aFrom the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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M.D. Malinzak
aFrom the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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S. Cantrell
cDuke University Medical Center Library (S.C.), Duke University School of Medicine, Durham, North Carolina
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C.R. Deline
eSpinal CSF Leak Foundation (C.R.D.), Spokane, Washington
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C.M. Carr
fDepartment of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
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D.K. Kim
fDepartment of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
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K.M. Goldstein
bDivision of General Internal Medicine (J.W.W., K.M.G.)
dDurham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
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P.G. Kranz
aFrom the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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Article Figures & Data

Figures

  • FIG 1.
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    FIG 1.

    Evidence map or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart. The asterisk indicates Martin 2019,26 Ohtonari 2012,27 Urbach 2020,28 Beck 2019,29 Pagani-Estevez 2019,30 Levi 2019,31 Franzini 2013,32 Watanabe 2011,33 Beck 2019,29 Angelo 2011;34 hash, Ferrante 2016,35 Ferrante 2015.36

  • FIG 2.
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    FIG 2.

    Timeline of included publications.

  • FIG 3.
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    FIG 3.

    Countries of origin for included studies.

  • FIG 4.
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    FIG 4.

    Evidence map of studies investigating treatments for SIH that included epidural patching and describing imaging-guidance methods. Note that each circle represents a single study with the area of the circle proportional to the study sample size; and colors represent the method of assessing a patient’s symptomatic response in each study, either a validated outcome measure (blue), subjective (nonvalidated) assessment (orange), or not reported (gray). RCT indicates randomized controlled trial.

  • FIG 5.
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    FIG 5.

    Evidence map of studies investigating treatments in SIH that included epidural patching and described the patching material used. RCT indicates randomized controlled trial.

  • FIG 6.
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    FIG 6.

    Evidence map of studies investigating treatments in SIH that included epidural patching and described targeted or nontargeted approaches. RCT indicates randomized controlled trial.

  • FIG 7.
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    FIG 7.

    Evidence map of studies investigating treatments in SIH that included surgery. RCT indicates randomized controlled trial.

  • FIG 8.
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    FIG 8.

    Methods of SIH diagnosis and types of CSF leaks.

  • FIG 9.
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    FIG 9.

    Outcome measures.

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T.J. Amrhein, J.W. Williams, L. Gray, M.D. Malinzak, S. Cantrell, C.R. Deline, C.M. Carr, D.K. Kim, K.M. Goldstein, P.G. Kranz
Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map
American Journal of Neuroradiology May 2023, DOI: 10.3174/ajnr.A7880

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Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map
T.J. Amrhein, J.W. Williams, L. Gray, M.D. Malinzak, S. Cantrell, C.R. Deline, C.M. Carr, D.K. Kim, K.M. Goldstein, P.G. Kranz
American Journal of Neuroradiology May 2023, DOI: 10.3174/ajnr.A7880
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