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<meta name="DC.Title" content="Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7880" />
<meta name="DC.Date" content="2023-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND: Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized.

PURPOSE: Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research.

DATA SOURCES: We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021.

STUDY SELECTION: We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension.

DATA ANALYSIS: One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author.

DATA SYNTHESIS: One hundred thirty-nine studies were included (median, 14 participants; range, 3–298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, n = 128). A few compared the efficacy of different treatments (10.8%, n = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, n = 86); however, 37.7% ( n = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% ( n = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, n = 118). Outcomes were rarely collected at uniform prespecified time points.

LIMITATIONS: The investigation did not include transvenous embolization of CSF-to-venous fistulas.

CONCLUSIONS: Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.

EBP
:   epidural blood patching
ICHD-3
:   International Classification of Headache Disorders-3
QOL
:   quality of life
SIH
:   spontaneous intracranial hypotension" />
<meta name="DC.Contributor" content="T.J. Amrhein" />
<meta name="DC.Contributor" content="J.W. Williams" />
<meta name="DC.Contributor" content="L. Gray" />
<meta name="DC.Contributor" content="M.D. Malinzak" />
<meta name="DC.Contributor" content="S. Cantrell" />
<meta name="DC.Contributor" content="C.R. Deline" />
<meta name="DC.Contributor" content="C.M. Carr" />
<meta name="DC.Contributor" content="D.K. Kim" />
<meta name="DC.Contributor" content="K.M. Goldstein" />
<meta name="DC.Contributor" content="P.G. Kranz" />
<meta name="article:published_time" content="2023-06-01" />
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<meta name="citation_title" content="Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;One hundred thirty-nine studies were included (median, 14 participants; range, 3–298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, &lt;i&gt;n&lt;/i&gt; = 128). A few compared the efficacy of different treatments (10.8%, &lt;i&gt;n&lt;/i&gt; = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, &lt;i&gt;n&lt;/i&gt; = 86); however, 37.7% (&lt;i&gt;n&lt;/i&gt; = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% (&lt;i&gt;n&lt;/i&gt; = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, &lt;i&gt;n&lt;/i&gt; = 118). Outcomes were rarely collected at uniform prespecified time points.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;The investigation did not include transvenous embolization of CSF-to-venous fistulas.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.&lt;/p&gt;" />
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<meta name="twitter:title" content="Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map" />
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<meta name="twitter:description" content="BACKGROUND: Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized.

PURPOSE: Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research.

DATA SOURCES: We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021.

STUDY SELECTION: We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension.

DATA ANALYSIS: One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author.

DATA SYNTHESIS: One hundred thirty-nine studies were included (median, 14 participants; range, 3–298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, n = 128). A few compared the efficacy of different treatments (10.8%, n = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, n = 86); however, 37.7% ( n = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% ( n = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, n = 118). Outcomes were rarely collected at uniform prespecified time points.

LIMITATIONS: The investigation did not include transvenous embolization of CSF-to-venous fistulas.

CONCLUSIONS: Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.

EBP
:   epidural blood patching
ICHD-3
:   International Classification of Headache Disorders-3
QOL
:   quality of life
SIH
:   spontaneous intracranial hypotension" />
<meta name="og-title" property="og:title" content="Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/44/6/730" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized.

PURPOSE: Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research.

DATA SOURCES: We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021.

STUDY SELECTION: We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension.

DATA ANALYSIS: One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author.

DATA SYNTHESIS: One hundred thirty-nine studies were included (median, 14 participants; range, 3–298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, n = 128). A few compared the efficacy of different treatments (10.8%, n = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, n = 86); however, 37.7% ( n = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% ( n = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, n = 118). Outcomes were rarely collected at uniform prespecified time points.

LIMITATIONS: The investigation did not include transvenous embolization of CSF-to-venous fistulas.

CONCLUSIONS: Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.

EBP
:   epidural blood patching
ICHD-3
:   International Classification of Headache Disorders-3
QOL
:   quality of life
SIH
:   spontaneous intracranial hypotension" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">T.J. Amrhein</span>, <span class="highwire-citation-author" data-delta="1">J.W. Williams</span>, <span class="highwire-citation-author" data-delta="2">L. Gray</span>, <span class="highwire-citation-author" data-delta="3">M.D. Malinzak</span>, <span class="highwire-citation-author" data-delta="4">S. Cantrell</span>, <span class="highwire-citation-author" data-delta="5">C.R. Deline</span>, <span class="highwire-citation-author" data-delta="6">C.M. Carr</span>, <span class="highwire-citation-author" data-delta="7">D.K. Kim</span>, <span class="highwire-citation-author" data-delta="8">K.M. Goldstein</span> and <span class="highwire-citation-author" data-delta="9">P.G. Kranz</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2023,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">730-739; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7880 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-102710--6650306778" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">T.J. Amrhein </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.J.%2BAmrhein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Amrhein%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.J.%2BAmrhein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9354-9486" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.J. Amrhein</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.W. Williams <span class="nlm-suffix">Jr</span></div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Division of General Internal Medicine (J.W.W., K.M.G.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Durham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.W.%2BWilliams%2B%3Cspan%2Bclass%3D%22nlm-suffix%22%3EJr%3C/span%3E" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Williams%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.W.%2BWilliams%2BJr" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5267-5558" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.W. Williams <span class="nlm-suffix">Jr</span></a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">L. Gray </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BGray%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gray%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BGray%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5947-9552" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Gray</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.D. Malinzak </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.D.%2BMalinzak%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Malinzak%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.D.%2BMalinzak%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6007-6520" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.D. Malinzak</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">S. Cantrell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Duke University Medical Center Library (S.C.), Duke University School of Medicine, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BCantrell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cantrell%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BCantrell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2694-7836" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. 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Deline </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Spinal CSF Leak Foundation (C.R.D.), Spokane, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.R.%2BDeline%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Deline%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.R.%2BDeline%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">C.M. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-44.6.730.1" data-doi="10.1016/j.rcl.2018.10.004"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Amrhein</span>  <span class="cit-name-given-names">TJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kranz</span>  <span class="cit-name-given-names">PG</span></span></li></ol><cite>. <span class="cit-article-title">Spontaneous intracranial hypotension: imaging in diagnosis and treatment</span>. <abbr class="cit-jnl-abbrev">Radiol Clin North Am</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">57</span>:<span class="cit-fpage">439</span>–<span class="cit-lpage">51</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1016/j.rcl.2018.10.004</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>30709479</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.rcl.2018.10.004&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=30709479&amp;link_type=MED&amp;atom=%2Fajnr%2F44%2F6%2F730.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-44.6.730.2" data-doi="10.1016/j.nic.2019.07.006"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kranz</span>  <span class="cit-name-given-names">PG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gray</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Malinzak</span>  <span class="cit-name-given-names">MD</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Spontaneous intracranial hypotension: pathogenesis, diagnosis, and treatment</span>. <abbr class="cit-jnl-abbrev">Neuroimaging Clin N Am</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">29</span>:<span class="cit-fpage">581</span>–<span class="cit-lpage">94</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1016/j.nic.2019.07.006</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>31677732</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.nic.2019.07.006&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=31677732&amp;link_type=MED&amp;atom=%2Fajnr%2F44%2F6%2F730.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-44.6.730.3" data-doi="10.1111/j.1468-1331.2009.02913.x"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span 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Headache Pain</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">16</span>:<span class="cit-fpage">A125</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1186/1129-2377-16-S1-A125</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28132263</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1186/1129-2377-16-S1-A125&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=28132263&amp;link_type=MED&amp;atom=%2Fajnr%2F44%2F6%2F730.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">730-739; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7880 </span></div>
  
  
  
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      <div class="highwire-cite-title">Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Amrhein</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.W.</span> <span class="nlm-surname">Williams</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Gray</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.D.</span> <span class="nlm-surname">Malinzak</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Cantrell</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">C.R.</span> <span class="nlm-surname">Deline</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.M.</span> <span class="nlm-surname">Carr</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.K.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">K.M.</span> <span class="nlm-surname">Goldstein</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">P.G.</span> <span class="nlm-surname">Kranz</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">730-739; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7880 </span></div>
  
  
  
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