{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T13:54:29Z","timestamp":1777730069182,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension (SIH) is a severe condition caused by cerebrospinal fluid (CSF) leaks, leading to headaches and neurological impairments. Traditional epidural blood patch treatment is often ineffective, especially in refractory cases without a source leak identified. This study introduces and evaluates the Catheter-Assisted Sealing Technique (CAST), a novel neurointerventional approach for refractory SIH. CAST involves targeted or diffuse delivery of fibrin glue into the epidural space to repair CSF leaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective case series of ten patients with refractory SIH underwent CAST using a fluoroscopy-guided epidural catheter approach. Clinical symptom resolution and follow-up MRI findings were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine of 10 patients achieved complete headache resolution and associated symptom relief. One patient experienced significant improvement without complete relief. Follow-up MRI showed resolution of pachymeningeal enhancement in all patients. One patient required repeat procedures for recurrent symptoms. No neurological injury or spinal cord compression occurred, with the only complication being transient femoral nerve palsy due to positioning that resolved within four months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CAST is a promising, minimally invasive alternative for refractory SIH. It enables targeted or diffuse fibrin sealant application, providing a seemingly effective leak closure even in cases of occult or multifocal leaks. Early results show high success and safety rates, but larger cohorts and extended follow-up are needed to validate it as a standard treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15910199251376452","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T19:39:55Z","timestamp":1759261195000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula"],"prefix":"10.1177","author":[{"given":"Mario","family":"Zanaty","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7597-9466","authenticated-orcid":false,"given":"Clayton Lawrence","family":"Rosinski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Elshikh","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Kinariwala","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Dlouhy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8965-2413","authenticated-orcid":false,"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minako","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Department of Radiology, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-1297","authenticated-orcid":false,"given":"Santiago","family":"Ortega-Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.4799"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211048510"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4706"},{"key":"e_1_3_2_5_2","unstructured":"Liaquat MT Jain S. Spontaneous intracranial hypotension. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559066\/ (2024 accessed 9 August 2024)."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.12.1713"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7548"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002986"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-022-03079-5"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-004-0273-9"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1159\/000206856"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2006.00383.x"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2015.07.009"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024221140471"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.1.JNS111568"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.4103\/1793-5482.161168"},{"key":"e_1_3_2_17_2","article-title":"A two-level large-volume epidural blood patch protocol for spontaneous intracranial hypotension: retrospective analysis of risk and benefit","author":"Martin R","unstructured":"Martin R, Louy C, Babu V, et al. A two-level large-volume epidural blood patch protocol for spontaneous intracranial hypotension: retrospective analysis of risk and benefit. Reg Anesth Pain Med 2019; 45: 32\u201337.","journal-title":"Reg Anesth Pain Med"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-009-9121-y"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2015\/18\/343"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3233\/THC-241366"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-007-0421-8"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7014"},{"issue":"3","key":"e_1_3_2_23_2","first-page":"159101992211090","article-title":"Combined CSF-venous fistula and middle meningeal artery embolization for treatment of spontaneous intracranial hypotension","volume":"31","author":"Madhavan AA","year":"2022","unstructured":"Madhavan AA, Cutsforth-Gregory JK, Oushy SH, et al. Combined CSF-venous fistula and middle meningeal artery embolization for treatment of spontaneous intracranial hypotension. 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