Cerebrospinal fluid (CSF) hypovolemia may result from dural puncture, surgery, trauma, or spontaneously. When loss of CSF exceeds CSF production, the resultant low CSF pressure may result in traction on the dura, epidural veins, and cranial nerves. Postural headache and cervicalgia are common presenting symptoms. However, the sagging of the brain could lead to more serious complications owing to potential compression of the diencephalon or ischemic traction on the cranial nerves resulting in permanent neurological deficits. Coma and even death due to spontaneous intracranial hypotension have been reported. Frequently, CSF hypovolemia resolves spontaneously without treatment, since CSF production is a continuous process and CSF equilibrium may be restored with spontaneous sealing of a dural leak without any intervention. However, both conservative and interventional therapies exist for treatment of symptomatic patients. This chapter will address the potential application of epidural blood patches and fibrin patches for treatment of CSF hypovolemia syndromes. Patient selection criteria, techniques, and potential complications will be discussed.
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