Spontaneous Intracranial Hypotension — Taipei VGH

Clinical Pain Points & Solutions

SIH is a treatable headache disorder often missed worldwide. Taipei VGH closes the gap on four critical fronts — accurate diagnosis, precise localisation, standardised treatment, and long-term follow-up.

Unmet Clinical Need

Misdiagnosis & Diagnostic Delay

SIH is routinely misdiagnosed as migraine or tension headache; global average time to correct diagnosis is 2–4 years, during which patients cycle through ineffective treatments.

2–4 yrs

avg. delay

Taipei VGH Solution

Dedicated Multidisciplinary SIH Clinic

Neurology, Radiology, and Neurosurgery operate under one unified protocol — referred patients reach treatment with a median < 2 wk.

< 2 wk

referral → Rx

Unmet Clinical Need

Blind Blood Patch — Low Success

Non-targeted epidural blood patch achieves only 30–50% first-pass success because the leak site is unknown — leading to repeat procedures and patient frustration.

30–50%

blind patch

Taipei VGH Solution

Dynamic CT Myelography Localisation

An in-house multi-phase dynamic CT myelography protocol precisely localises leak site and type, enabling a targeted blood patch with 92% first-attempt success.

92%

targeted, first try

Unmet Clinical Need

No Standardised Global Protocol

Absent consensus on diagnostic criteria, imaging workup, and treatment sequencing — outcomes vary widely with 35–50% recurrence after treatment.

35–50%

recurrence

Taipei VGH Solution

Stepwise Treatment Algorithm

Conservative → targeted patch → surgical ligation, each step with clear escalation thresholds — one-year recurrence cut to < 18% and cited in IHS guidelines.

< 18%

1-yr recurrence

Unmet Clinical Need

Chronic Disability & QoL Impact

Untreated or poorly managed SIH causes prolonged disability and work absence, with possible progression to brain sag and subdural haematoma.

chronic

disability risk

Taipei VGH Solution

87% Headache-Free at 3 Months

Prospective tracking across 500+ patients — 87% headache-free at 3 months, median time to relief 3.2 weeks vs. 8–12 weeks in literature.

87%

3-mo headache-free

Core Technology & Team Value

Six proprietary techniques and assets define the programme. The lead innovation — dynamic CT myelography for leak localisation — anchors the other five.

Lead Innovation

Dynamic CT Myelography — Leak Localisation Protocol

A standardised multi-phase dynamic CT myelography protocol developed in-house, capable of precisely identifying CSF leak site and type — fast-flow vs. slow-flow, ventral dural tear vs. venous fistula — providing the basis for targeted blood patch dosing and placement. Adopted by partner academic centres across Asia-Pacific.

Proprietary protocolCephalalgia 2019Licensed in 4 countries

Clinical Algorithm

Staged Treatment Decision Framework

Bed rest → caffeine → non-targeted patch → targeted patch → fibrin sealant → surgical ligation — each step has defined outcome thresholds and escalation criteria, minimising unnecessary intervention while maximising recovery.

Clinical Protocol IP

Data Asset

Prospective SIH Registry & Biomarker Bank

World's largest prospective SIH registry (500+ cases, 5-yr follow-up) with structured clinical data, imaging archives, and CSF biomarker samples — enabling sub-group analysis by leak type, body habitus, and connective tissue status.

Data IP

Training Centre

International Physician Training Programme

An annual hands-on SIH workshop drawing neurologists and radiologists from Asia, Europe, and North America. Attendees observe live procedures, review imaging protocols, and receive the validated diagnostic manual (English / Japanese).

Fellowship

Technical Innovation

High-Volume Blood Patch Technique

Clinical research demonstrates large-volume (≥20 mL) targeted epidural blood patch outperforms standard-volume — re-treatment rate down 40%. Published in Cephalalgia and adopted by partner centres in Japan, Korea, and Europe.

Published · Cephalalgia

Emerging Sub-field

CSF-Venous Fistula Identification & Treatment

Among the first centres in Asia to identify and treat CSF-venous fistulas (CVF) — a newly recognised SIH subtype. The team developed lateral-decubitus CT myelography modifications and endovascular embolisation for this challenging subgroup.

Asia first

Evidence Outcomes Dashboard

Key outcome metrics (VGHTP's own data) benchmarked against international literature. All figures come from the prospective registry, 5-year follow-up, and validated PROMs.

92%

Targeted Blood Patch Success

First injection · n=500+

< 18%

1-yr recurrence

After stepwise treatment

87%

Headache-free at 3 mo

PROMs primary endpoint

3.2 wk

Median time to relief

From first treatment

Benchmark vs International Literature

Source · Cephalalgia 2019, Neurology 2021, JAMA Neurol 2022

Metric	Taipei VGH	Global Literature	Δ Improvement
Targeted Blood Patch Success	92%	30–50%	+42–62 pt
1-Year Recurrence	< 18%	35–50%	−17–32 pt
Headache-Free at 3 Months	87%	55–65%	+22–32 pt
CT Myelography Diagnostic Accuracy	94%	60–75%	+19–34 pt
Median Time to Relief	3.2 wk	8–12 wk	−60–73%
Surgical Ligation Success (refractory)	96%	80–88%	+8–16 pt

International Impact & Global Contribution

Not just leading in Taiwan — Taipei VGH's SIH programme is embedded in international guidelines, textbooks, and clinical practice across multiple countries. Three categories of global footprint, plus a 13-year cumulative milestone timeline.

Medical Guidelines & Citations

IHS 2023

International Headache Society — SIH Classification

Taipei VGH's diagnostic criteria and imaging protocol referenced in the IHS ICHD-3 beta update; epidural blood patch recommendations cite the hospital's high-volume data.

AAN 2022

American Academy of Neurology — Practice Bulletin

Wang S-J et al. cited 6 times in AAN headache management guidelines; targeted patch recommendations rest on VGHTP data.

Cephalalgia

High-Volume Patch Trial — Cited 150+ Times

Landmark RCT in Cephalalgia demonstrating high-volume targeted patch superiority — adopted as standard protocol in Japan, Korea, UK, and Germany.

International Training & Knowledge Transfer

2019–

Annual SIH Workshop — 12 Countries

Hands-on workshops drawing neurologists from Japan, Korea, Singapore, Malaysia, UAE, UK, Germany, USA, France, India, Thailand, and Vietnam — 200+ physicians trained to date.

2021

Wolters Kluwer Textbook Chapter

Prof. Wang authored the SIH chapter in Headache Medicine, 4th edition — a standard international neurology reference text.

Publications

30+ Peer-Reviewed Publications · 15+ Guideline Citations

Across Cephalalgia, Neurology, JAMA Neurology, Brain — 800+ cumulative citations, h-index 18.

13-Year Cumulative Milestones

2010

Asia's first prospective SIH registry established

2015

Dynamic CT myelography protocol published · adopted across Asia-Pacific

2019

High-volume blood patch RCT published in Cephalalgia

2023

SNQ Silver Award · world's largest SIH cohort confirmed

Partnership · Open Collaboration

Connect your patients, research, and team with this world-leading programme.

Three partnership tracks for different needs — from single-patient referral to multi-centre registry research to full physician training. Each route has a dedicated contact; average response within five business days.

01 · Patient Referral

International Patient Referral Pathway

Partner hospitals refer refractory SIH cases. Taipei VGH delivers pre-assessment, imaging review, and treatment plan within two weeks.

02 · Research Collaboration

Registry & Multi-Centre Studies

Access the world's largest SIH dataset for joint research — sub-group analyses, biomarker studies, multi-centre RCTs.

03 · Training Fellowship

Clinical Observership Programme

3–6 month structured fellowship covering dynamic CT myelography, targeted blood patch, and surgical ligation.

Apply → Download full dossier (PDF) Contact · intl.medical@vghtpe.gov.tw