{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T14:50:57Z","timestamp":1775746257465,"version":"3.50.1"},"reference-count":45,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jocn-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Neuroscience"],"published-print":{"date-parts":[[2023,5]]},"DOI":"10.1016\/j.jocn.2023.03.005","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T16:27:15Z","timestamp":1679329635000},"page":"46-56","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":9,"special_numbering":"C","title":["Spontaneous Intracranial Hypotension and Spinal Epidural CSF Leaks: Diagnosis and Management"],"prefix":"10.1016","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4109-4715","authenticated-orcid":false,"given":"Simran","family":"Rajpal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9777-2979","authenticated-orcid":false,"given":"Mithun","family":"Nambiar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-809X","authenticated-orcid":false,"given":"Damian","family":"Castanelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5077-8449","authenticated-orcid":false,"given":"Ali","family":"Khabaza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2475-9727","authenticated-orcid":false,"given":"Hamed","family":"Asadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ash","family":"Jhamb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duncan","family":"Mark Brooks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Maingard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"7","key":"10.1016\/j.jocn.2023.03.005_b0005","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1111\/head.12149","article-title":"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks","volume":"53","author":"Mokri","year":"2013","journal-title":"Headache"},{"issue":"8","key":"10.1016\/j.jocn.2023.03.005_b0010","first-page":"E1115","article-title":"Epidural Blood Patch for the Treatment of Spontaneous and Iatrogenic Orthostatic Headache","volume":"19","author":"So","year":"2016","journal-title":"Pain Physician"},{"issue":"7","key":"10.1016\/j.jocn.2023.03.005_b0015","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1212\/WNL.0000000000002986","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","journal-title":"Neurology"},{"key":"10.1016\/j.jocn.2023.03.005_b0020","first-page":"565","article-title":"Treatment of postspinal headache","volume":"21","author":"Jb","year":"1960","journal-title":"Anesthesiology"},{"issue":"19","key":"10.1016\/j.jocn.2023.03.005_b0025","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1001\/jama.295.19.2286","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension","volume":"295","author":"Schievink","year":"2006","journal-title":"JAMA"},{"issue":"2","key":"10.1016\/j.jocn.2023.03.005_b0030","first-page":"320","article-title":"Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature","volume":"25","author":"Girgis","year":"2015","journal-title":"Turk Neurosurg"},{"issue":"4","key":"10.1016\/j.jocn.2023.03.005_b0035","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1177\/0300060516645955","article-title":"Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review","volume":"44","author":"Zhang","year":"2016","journal-title":"J Int Med Res"},{"issue":"4","key":"10.1016\/j.jocn.2023.03.005_b0040","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.nic.2019.07.006","article-title":"Spontaneous Intracranial Hypotension: Pathogenesis, Diagnosis, and Treatment","volume":"29","author":"Kranz","year":"2019","journal-title":"Neuroimaging Clin N Am"},{"issue":"6","key":"10.1016\/j.jocn.2023.03.005_b0045","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s11916-014-0425-4","article-title":"Low-pressure\/spinal fluid leak headache","volume":"18","author":"Spears","year":"2014","journal-title":"Curr Pain Headache Rep"},{"issue":"12","key":"10.1016\/j.jocn.2023.03.005_b0050","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1212\/WNL.56.12.1746","article-title":"The Monro-Kellie hypothesis: applications in CSF volume depletion","volume":"56","author":"Mokri","year":"2001","journal-title":"Neurology"},{"issue":"7","key":"10.1016\/j.jocn.2023.03.005_b0055","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.3174\/ajnr.A4689","article-title":"Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure","volume":"37","author":"Kranz","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0060","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3174\/ajnr.A6844","article-title":"Decubitus CT Myelography for CSF-Venous Fistulas: A Procedural Approach","volume":"42","author":"Mamlouk","year":"2021","journal-title":"AJNR Am J Neuroradiol"},{"issue":"10","key":"10.1016\/j.jocn.2023.03.005_b0065","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1136\/neurintsurg-2021-018466","article-title":"Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization","volume":"14","author":"Brinjikji","year":"2022","journal-title":"J Neurointerv Surg"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0070","doi-asserted-by":"crossref","first-page":"8","DOI":"10.2214\/AJR.15.14884","article-title":"Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension","volume":"206","author":"Kranz","year":"2016","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jocn.2023.03.005_b0075","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.wneu.2016.09.076","article-title":"Value of Targeted Epidural Blood Patch and Management of Subdural Hematoma in Spontaneous Intracranial Hypotension: Case Report and Review of the Literature","volume":"97","author":"Rettenmaier","year":"2017","journal-title":"World Neurosurg"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0080","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s10194-016-0708-8","article-title":"The status of diagnosis and treatment to intracranial hypotension, including SIH","volume":"18","author":"Lin","year":"2017","journal-title":"J Headache Pain"},{"issue":"5","key":"10.1016\/j.jocn.2023.03.005_b0085","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1001\/jamaneurol.2018.4921","article-title":"Assessing Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension With a Scoring System Based on Brain Magnetic Resonance Imaging Findings","volume":"76","author":"Dobrocky","year":"2019","journal-title":"JAMA Neurol"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0090","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2000.9.1.7","article-title":"Surgical treatment of spontaneous spinal cerebrospinal fluid leaks","volume":"9","author":"Maher","year":"2000","journal-title":"Neurosurg Focus"},{"issue":"10","key":"10.1016\/j.jocn.2023.03.005_b0095","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.3174\/ajnr.A6765","article-title":"Safety of Consecutive Bilateral Decubitus Digital Subtraction Myelography in Patients with Spontaneous Intracranial Hypotension and Occult CSF Leak","volume":"41","author":"Pope","year":"2020","journal-title":"AJNR Am J Neuroradiol"},{"issue":"7","key":"10.1016\/j.jocn.2023.03.005_b0100","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.3174\/ajnr.A6592","article-title":"Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences","volume":"41","author":"Dobrocky","year":"2020","journal-title":"AJNR Am J Neuroradiol"},{"issue":"27\u201328","key":"10.1016\/j.jocn.2023.03.005_b0105","first-page":"480","article-title":"Spontaneous Intracranial Hypotension","volume":"117","author":"Urbach","year":"2020","journal-title":"Dtsch Arztebl Int"},{"issue":"6","key":"10.1016\/j.jocn.2023.03.005_b0110","doi-asserted-by":"crossref","first-page":"960","DOI":"10.3171\/2015.10.SPINE15855","article-title":"Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulas","volume":"24","author":"Schievink","year":"2016","journal-title":"J Neurosurg Spine"},{"issue":"6","key":"10.1016\/j.jocn.2023.03.005_b0115","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3171\/2019.6.SPINE19487","article-title":"Lateral decubitus digital subtraction myelography to identify spinal CSF-venous fistulas in spontaneous intracranial hypotension","volume":"31","author":"Schievink","year":"2019","journal-title":"J Neurosurg Spine"},{"key":"10.1016\/j.jocn.2023.03.005_b0120","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/978-3-211-85578-2_31","article-title":"Pathophysiology and diagnosis of spontaneous intracranial hypotension","volume":"102","author":"Shima","year":"2008","journal-title":"Acta Neurochir Suppl"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0125","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3988\/jcn.2020.16.1.1","article-title":"Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid","volume":"16","author":"Kanno","year":"2020","journal-title":"J Clin Neurol"},{"issue":"2","key":"10.1016\/j.jocn.2023.03.005_b0130","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1136\/rapm-2018-000021","article-title":"Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension","volume":"44","author":"Pagani-Est\u00e9vez","year":"2019","journal-title":"Reg Anesth Pain Med"},{"issue":"10","key":"10.1016\/j.jocn.2023.03.005_b0135","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1111\/j.1399-6576.2012.02742.x","article-title":"Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch","volume":"56","author":"Bele\u00f1a","year":"2012","journal-title":"Acta Anaesthesiol Scand"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0140","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/rapm-2019-100851","article-title":"Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic?","volume":"45","author":"Narouze","year":"2020","journal-title":"Reg Anesth Pain Med"},{"issue":"2","key":"10.1016\/j.jocn.2023.03.005_b0145","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1093\/brain\/aww328","article-title":"Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension","volume":"140","author":"Wu","year":"2017","journal-title":"Brain"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0150","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1213\/ANE.0b013e318218204d","article-title":"The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial","volume":"113","author":"Paech","year":"2011","journal-title":"Anesth Analg"},{"key":"10.1016\/j.jocn.2023.03.005_b0155","doi-asserted-by":"crossref","unstructured":"Rahman M, Bidari SS, Quisling RG, Friedman WA. Spontaneous intracranial hypotension: dilemmas in diagnosis. Neurosurgery. 2011;69(1):4-14; discussion.","DOI":"10.1227\/NEU.0b013e3182134399"},{"issue":"13","key":"10.1016\/j.jocn.2023.03.005_b0160","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1212\/WNL.0b013e318212ab43","article-title":"Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch","volume":"76","author":"Cho","year":"2011","journal-title":"Neurology"},{"issue":"10","key":"10.1016\/j.jocn.2023.03.005_b0165","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1212\/WNL.57.10.1921","article-title":"The efficacy of epidural blood patch in spontaneous CSF leaks","volume":"57","author":"Sencakova","year":"2001","journal-title":"Neurology"},{"issue":"2","key":"10.1016\/j.jocn.2023.03.005_b0170","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1136\/practneurol-2015-001343","article-title":"Management of spontaneous intracranial hypotension","volume":"16","author":"Tyagi","year":"2016","journal-title":"Pract Neurol"},{"issue":"9","key":"10.1016\/j.jocn.2023.03.005_b0175","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.3174\/ajnr.A3945","article-title":"Large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for treatment of spontaneous intracranial hypotension","volume":"35","author":"Griauzde","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0180","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3344\/kjp.2010.23.1.46","article-title":"Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension","volume":"23","author":"Kim","year":"2010","journal-title":"Korean J Pain"},{"issue":"6","key":"10.1016\/j.jocn.2023.03.005_b0185","first-page":"1098","article-title":"Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant","volume":"100","author":"Schievink","year":"2004","journal-title":"Report of four cases J Neurosurg"},{"issue":"4","key":"10.1016\/j.jocn.2023.03.005_b0190","first-page":"745","article-title":"Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography","volume":"40","author":"Farb","year":"2019","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0195","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1186\/s40064-016-1975-1","article-title":"Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report","volume":"5","author":"Elwood","year":"2016","journal-title":"Springerplus"},{"issue":"5","key":"10.1016\/j.jocn.2023.03.005_b0200","doi-asserted-by":"crossref","first-page":"882","DOI":"10.3174\/ajnr.A7014","article-title":"A Novel Endovascular Therapy for CSF Hypotension Secondary to CSF-Venous Fistulas","volume":"42","author":"Brinjikji","year":"2021","journal-title":"AJNR Am J Neuroradiol"},{"issue":"4","key":"10.1016\/j.jocn.2023.03.005_b0205","doi-asserted-by":"crossref","first-page":"579","DOI":"10.36076\/ppj.2007\/10\/579","article-title":"Transforaminal epidural blood patch","volume":"10","author":"Weil","year":"2007","journal-title":"Pain Physician"},{"issue":"4","key":"10.1016\/j.jocn.2023.03.005_b0210","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/AJP.0b013e3182038463","article-title":"Bilateral cervicothoracic transforaminal blood patches for persistent headache from spontaneous intracranial hypotension: a case report and review","volume":"27","author":"Walega","year":"2011","journal-title":"Clin J Pain"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0215","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40981-016-0073-2","article-title":"Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak: a case report","volume":"3","author":"Fujiwara","year":"2017","journal-title":"JA Clin Rep"},{"key":"10.1016\/j.jocn.2023.03.005_b0220","first-page":"1","article-title":"Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome","volume":"2019","author":"Choi","year":"2019","journal-title":"Case Rep Neurol Med"},{"issue":"1","key":"10.1016\/j.jocn.2023.03.005_b0225","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1055\/s-0030-1247552","article-title":"Diagnostics and treatment of spontaneous intracranial hypotension","volume":"53","author":"Schick","year":"2010","journal-title":"Minim Invasive Neurosurg"}],"container-title":["Journal of Clinical Neuroscience"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0967586823000620?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0967586823000620?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:33:00Z","timestamp":1760823180000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0967586823000620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":45,"alternative-id":["S0967586823000620"],"URL":"https:\/\/doi.org\/10.1016\/j.jocn.2023.03.005","relation":{},"ISSN":["0967-5868"],"issn-type":[{"value":"0967-5868","type":"print"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Spontaneous Intracranial Hypotension and Spinal Epidural CSF Leaks: Diagnosis and Management","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical Neuroscience","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jocn.2023.03.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Crown Copyright \u00a9 2023 Published by Elsevier Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}