When should CT-guided blood patch be considered for patients with spontaneous intracranial hypotension headache?

First of all, I think the epidural blood patch for Spontaneous Intracranial Hypotension (SIH) should always be CT-guided and not XR-guided or "blind", whenever possible. And, while headache is present almost always, and the vast majority of the time the headache is orthostatic, the SIH syndrome is not just headache. That being said, I think the CT-guided blood patch should be considered whenever:

• A spinal CSF leak site is identified on imaging
• A spinal CSF leak site is suspected on imaging (the article by Callen et al., PMID 40139902 is useful)
• A CSF-venous fistula is identified or strongly suspected (fibrin glue may be preferable)
• There is a strong clinical suspicion (e.g., clear orthostatic headache +/- associated symptoms, without other ...