{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T14:14:36Z","timestamp":1784211276256,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Current guidelines for postdural puncture cerebrospinal fluid (CSF) leakage advocate conservative management, extrapolated from general populations. Patients with refractory cancer pain (RCP) often have advanced disease, malnutrition, and hypoalbuminemia, which may compromise tissue repair and reduce the reliability of spontaneous dural closure. The role of prophylactic epidural blood patch (PEBP) in this high-risk subgroup is undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study enrolled RCP patients undergoing intrathecal drug delivery system (IDDS) implantation (Jan 2023\u2013Aug 2025). Patients received either intraoperative PEBP (10\u201315\u202fmL autologous blood) or conservative management (strict bed rest for 24\u201348\u202fh, intravenous hydration 1,500\u20132,000\u202fmL\/day, oral caffeine). Propensity score matching (1:1) balanced recorded baseline and available procedural covariates. The primary outcome was moderate-to-severe postural headache syndrome (PHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching (78 patient pairs,\n                      <jats:italic>N<\/jats:italic>\n                      =\u202f156), PEBP was associated with lower rates of moderate-to-severe PHS (6.41% vs. 25.64%;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), exploratory imaging-confirmed CSF leakage (7.69% vs. 24.36%;\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.003), and remedial EBP requirement (2.56% vs. 15.38%;\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.006). The absolute risk reduction for moderate-to-severe PHS was 19.23%, corresponding to a number needed to treat (NNT) of approximately 5. Headache duration and hospital stay were also shorter in the PEBP group. Subgroup findings were exploratory. Minor adverse events occurred in 11.54% of PEBP patients. No clinically evident neuraxial seeding was observed during short-term follow-up (median 3\u202fmonths, range 2\u20135\u202fmonths).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective cohort, intraoperative PEBP was associated with fewer early CSF leakage-related complications and shorter recovery after adjustment for recorded covariates. These findings support further prospective evaluation of PEBP in carefully selected patients. Prospective randomized controlled trials are warranted to validate these results. Causal inference, long-term safety, and patient-centered benefit require confirmation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1883156","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T13:47:17Z","timestamp":1784209637000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prophylactic epidural blood patch for cerebrospinal fluid leakage after intrathecal drug delivery system implantation in patients with refractory cancer pain: a multi-center retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Aimin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Sichuan Women's and Children's Hospital\/Women's and Children's Hospital, Chengdu Medical College","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiju","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology, Chengdu Xinhua Hospital, Xinhua Hospital Affiliated to North Sichuan Medical College","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zikun","family":"Ning","sequence":"additional","affiliation":[{"name":"Graduate School, Guangxi University of Chinese Medicine","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain, The People's Hospital of Leshan","place":["Leshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Yanjiang District People's Hospital","place":["Ziyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deshan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Interventional Therapy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengjiu","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, The Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou Traditional Chinese Medical Hospital","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s00520-024-08706-w","article-title":"Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled study","volume":"32","author":"Sulistio","year":"2024","journal-title":"Support Care Cancer"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12904-022-01076-2","article-title":"Methadone switching for refractory cancer pain","volume":"21","author":"Ding","year":"2022","journal-title":"BMC Palliat Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"32072","DOI":"10.1038\/s41598-024-83799-1","article-title":"Efficacy and safety of single and double catheter intrathecal drug delivery systems in patients with refractory neck and abdominal cancer pain","volume":"14","author":"Li","year":"2024","journal-title":"Sci Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s40122-024-00608-3","article-title":"Risk factors associated with postoperative cerebrospinal fluid leaks after intrathecal drug delivery system and an external pump implantation in cancer patients: a retrospective study","volume":"13","author":"Li","year":"2024","journal-title":"Pain Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E211","DOI":"10.36076\/ppj.2021.24.E211-E220","article-title":"Preventing post dural puncture headache after intrathecal drug delivery system implantation through preventive fibrin glue application: a retrospective study","volume":"24","author":"Dupoiron","year":"2021","journal-title":"Pain Physician"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e2851","DOI":"10.1002\/brb3.2851","article-title":"Comparison of external system and implanted system in intrathecal therapy for refractory cancer pain in China: a retrospective study","volume":"13","author":"Qin","year":"2023","journal-title":"Brain Behav"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"8365296","DOI":"10.1155\/2020\/8365296","article-title":"It is just a blood patch: considerations for patients with preexisting intracranial hypertension","volume":"2020","author":"Shiwlochan","year":"2020","journal-title":"Case Rep Anesthesiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e2325387","DOI":"10.1001\/jamanetworkopen.2023.25387","article-title":"Consensus practice guidelines on postdural puncture headache from a multisociety, international working group: a summary report","volume":"6","author":"Uppal","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1136\/rapm-2023-104817","article-title":"Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group","volume":"49","author":"Uppal","year":"2024","journal-title":"Reg Anesth Pain Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: clinical nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1093\/pm\/pnw218","article-title":"Cancer seeding risk from an epidural blood patch in patients with leukemia or lymphoma","volume":"18","author":"Demaree","year":"2017","journal-title":"Pain Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/cm9.0000000000001967","article-title":"Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture","volume":"136","author":"Zhou","year":"2023","journal-title":"Chin Med J"},{"key":"ref13","first-page":"8254","article-title":"Epidural injection of hydroxyethyl starch in the management of post-dural puncture headache: a case series","volume":"8","author":"Sun","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"485","DOI":"10.36076\/ppj.2023.26.485","article-title":"Prophylactic epidural blood patch or prophylactic epidural infusion of hydroxyethyl starch in preventing post-dural puncture headache - a retrospective study","volume":"26","author":"Fan","year":"2023","journal-title":"Pain Physician"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1186\/s12904-024-01501-8","article-title":"A nationwide neurosurgical inter-disciplinary service for cancer-related refractory pain","volume":"23","author":"Khashan","year":"2024","journal-title":"BMC Palliat Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/ner.12538","article-title":"The Polyanalgesic Consensus Conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines","volume":"20","author":"Deer","year":"2017","journal-title":"Neuromodulation"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"Cd009199","DOI":"10.1002\/14651858.CD009199.pub3","article-title":"Posture and fluids for preventing post-dural puncture headache","volume":"3","author":"Arevalo-Rodriguez","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1016\/j.bja.2021.05.020","article-title":"Chronic disabling postpartum headache after unintentional dural puncture during epidural anaesthesia: a prospective cohort study","volume":"127","author":"Ansari","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: an international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jclinane.2014.07.008","article-title":"Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population","volume":"27","author":"Ranganathan","year":"2015","journal-title":"J Clin Anesth"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"697697","DOI":"10.1155\/2012\/697697","article-title":"Headache in pregnancy: a nuisance or a new sense?","volume":"2012","author":"Dixit","year":"2012","journal-title":"Obstet Gynecol Int"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1097\/00000539-200004000-00023","article-title":"Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine","volume":"90","author":"Garc\u00eda-Aguado","year":"2000","journal-title":"Anesth Analg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.bja.2020.11.041","article-title":"Epidural blood patch for post-dural puncture headaches in adult and paediatric patients with malignancies: a review","volume":"126","author":"Morgan","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e70239","DOI":"10.1111\/ene.70239","article-title":"Targeted versus nontargeted epidural blood patch for spontaneous intracranial hypotension: a systematic review and meta-analysis","volume":"32","author":"Palermo","year":"2025","journal-title":"Eur J Neurol"},{"key":"ref26","volume-title":"AJCC Cancer Staging Manual","author":"Amin","year":"2017"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/1475-2891-9-69","article-title":"Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature","volume":"9","author":"Gupta","year":"2010","journal-title":"Nutr J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1002\/ccr3.1429","article-title":"A case of late orthostatic headache secondary to lumbar hidden dural fistula 20 months after epidural anesthesia","volume":"6","author":"Ros Forteza","year":"2018","journal-title":"Clin Case Reports"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1883156\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T13:47:19Z","timestamp":1784209639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1883156\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":29,"alternative-id":["10.3389\/fneur.2026.1883156"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1883156","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"article-number":"1883156"}}