{
  "abstract": "Background Spontaneous intracranial hypotension (SIH) remains an underdiagnosed cause of disabling headache, often requiring specialized expertise and advanced imaging to identify challenging pathology such as elusive spinal CSF leaks or CSF–venous fistulas. In 2023, a large academic medical center sought to address this gap in care through the creation of an Intracranial Hypotension Center. An aspirational idea conceived years prior, the effort was initiated by a multidisciplinary group including a headache neurologist, neurointerventionalist, neuroradiologist, neurosurgeon, and pain management physician with the goal of building institutional capability for accurate diagnosis and effective treatment of SIH using contemporary best practices.Methods A formal task force was convened to identify all system resources, training needs, and workflow structures required to support a comprehensive SIH program. The group engaged in extensive professional development, including attendance at national SIH-focused conferences and collaboration with external experts and centers experienced in advanced diagnostic and therapeutic techniques. Training emphasized diagnostic tools including detection methods for CSF–venous fistulas such as dynamic myelography, as well as specialized treatments including targeted fibrin patching and endovascular fistula embolization. Monthly task force meetings were held to review emerging evidence, assess diagnostic criteria, discuss cases, and establish consensus protocols. Simultaneously, the institution upgraded imaging software and hardware, acquired additional resources including a photon counting CT scanner, developed specialized technician training, created standardized diagnostic pathways, and designed streamlined referral and treatment logistics.Results Within 18 months, the institution successfully launched a fully operational Intracranial Hypotension Center. All required imaging modalities, procedural capabilities, and interdisciplinary care pathways were established. To date, more than 30 patients have been evaluated and diagnosed with various SIH etiologies, including a variety of dural tears and leaks as well as CSF–venous fistulas. All patients have been successfully treated using targeted evidence-based techniques, representing a 100% treatment success rate within this initial cohort. The center has demonstrated the feasibility of rapidly building SIH expertise within a previously inexperienced clinical system through intentional multidisciplinary collaboration and structured learning.Conclusion This experience demonstrates that health systems without pre-existing SIH expertise can successfully develop a comprehensive intracranial hypotension program through coordinated multidisciplinary leadership, targeted training, evidence-based protocol development, and strategic resource allocation. The creation of this center has enabled timely diagnosis and effective treatment for a historically underserved patient population. This model may serve as a blueprint for other institutions seeking to expand SIH care capability and improve outcomes for patients with complex CSF disorders.Disclosures K. Duncan: None. A. Nayate: None. M. Lawrence: None. S. Hoffer: None. D. Reed: None.",
  "authors": [
    {
      "affiliations": [
        "Case Western Reserve Univ/Univ Hospitals Cleveland Medical Center, Cleveland, OH"
      ],
      "name": "K Duncan"
    },
    {
      "affiliations": [
        "Case Western Reserve Univ/Univ Hospitals Cleveland Medical Center, Cleveland, OH"
      ],
      "name": "A Nayate"
    },
    {
      "affiliations": [
        "Case Western Reserve Univ/Univ Hospitals Cleveland Medical Center, Cleveland, OH"
      ],
      "name": "M Lawrence"
    },
    {
      "affiliations": [
        "Case Western Reserve University, Cleveland, OH"
      ],
      "name": "S Hoffer"
    },
    {
      "affiliations": [
        "Case Western Reserve Univ/Univ Hospitals Cleveland Medical Center, Cleveland, OH"
      ],
      "name": "D Reed"
    }
  ],
  "title": "E-099 Establishing a comprehensive intracranial hypotension center: a multidisciplinary model for systemwide innovation",
  "uid": "5f7ba661-de80-501f-95ea-eec85cbec16a"
}