Epidural blood patch
Updates to Article Attributes
Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The procedure can be done blind or under fluoroscopic or CT guidance, and is performed predominantly by radiologists and anaesthetists.
Indications
- craniospinal hypotension
- post lumbar puncture headache
Contraindications
- allergy to any of the planned medications
- local or systemic infection
Procedure
Epidural blood patches can be targeted (i.e. preprocedure imaging has demonstrated the site of CSF leak) or non-targeted 2.
Accessing the spinal epidural space can be done under fluoroscopy or CT, and is essentially identical to one described in the article on lumbar interlaminar epidural injection.
The difference is that the patient has a sterile cannulation prior to , and then the patient's own blood is withdrawn and injected. The volume can be low volume (2-3 mL) or high volume (10-20 mL), and can be mixed with contrast to outline the epidural space.
Complications
Complications include 3,5:
- transient back pain : most common; pain may last up to 4 weeks 6
mild temperature elevation- radicular pain
- intrathecal haematoma
- spinal subdural haematoma
- cauda equina syndrome
- spinal epidural abscess
spinal subdural haematoma
Outcomes
Success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypertension and 90-99% for post lumbar puncture headache. In successful procedures the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse 1,4,5. Sometimes multiple blood patches are required for a successful outcome.
-<p><strong>Epidural blood patch</strong> is a treatment option for patients with symptomatic <a title="Spontaneous craniospinal hypotension" href="/articles/intracranial-hypotension-1">craniospinal hypotension</a> or post <a title="Fluoroscopy-guided lumbar puncture" href="/articles/fluoroscopy-guided-lumbar-puncture">lumbar puncture</a> headaches. </p><h4>Indications</h4><ul>- +<p><strong>Epidural blood patch</strong> is a treatment option for patients with <a href="/articles/intracranial-hypotension-1">craniospinal hypotension</a> or post <a href="/articles/fluoroscopy-guided-lumbar-puncture">lumbar puncture</a> headaches. The procedure can be done blind or under fluoroscopic or CT guidance, and is performed predominantly by radiologists and anaesthetists. </p><h4>Indications</h4><ul>
-</ul><h4>Procedure</h4><p>Epidural blood patches can be targeted (i.e. preprocedure imaging has demonstrated the site of CSF leak) or non-targeted <sup>2</sup>.</p><p>Accessing the epidural space can be done under fluoroscopy or CT, and is identical to one described in the article on <a title="Lumbar interlaminar epidural injections" href="/articles/lumbar-interlaminar-epidural-injection">lumbar interlaminar epidural injection</a>.</p><p>The difference is that the patient has a sterile cannulation, and then the patient's own blood is withdrawn and injected. The volume can be low volume (2-3 mL) or high volume (10-20 mL), and can be mixed with contrast. </p><h4>Complications</h4><p>Complications include 3,5:</p><ul>-<li>transient back pain </li>-<li>mild temperature elevation</li>- +</ul><h4>Procedure</h4><p>Epidural blood patches can be targeted (i.e. preprocedure imaging has demonstrated the site of CSF leak) or non-targeted <sup>2</sup>.</p><p>Accessing the <a href="/articles/spinal-epidural-space">spinal epidural space</a> can be done under fluoroscopy or CT, and is essentially identical to one described in the article on <a href="/articles/lumbar-interlaminar-epidural-injection">lumbar interlaminar epidural injection</a>.</p><p>The difference is that the patient has a sterile cannulation prior to , and then the patient's own blood is withdrawn and injected. The volume can be low (2-3 mL) or high (10-20 mL), and can be mixed with contrast to outline the epidural space. </p><h4>Complications</h4><p>Complications include <sup>3,5</sup>:</p><ul>
- +<li>transient back pain: most common; pain may last up to 4 weeks <sup>6</sup>
- +</li>
-<li><a title="Cauda equina syndrome" href="/articles/cauda-equina-syndrome">cauda equina syndrome</a></li>-<li><a title="Spinal epidural abscess" href="/articles/spinal-epidural-abscess">spinal epidural abscess</a></li>-<li>spinal subdural haematoma</li>-</ul><h4>Outcomes</h4><p>Success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypertension and 90-99% for post lumbar puncture headache. In successful procedures the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse <sup>1,4,5</sup>. </p>- +<li><a href="/articles/spinal-subdural-haematoma">spinal subdural haematoma</a></li>
- +<li><a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a></li>
- +<li><a href="/articles/spinal-epidural-abscess">spinal epidural abscess</a></li>
- +</ul><h4>Outcomes</h4><p>Success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypertension and 90-99% for post lumbar puncture headache. In successful procedures the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse <sup>1,4,5</sup>. Sometimes multiple blood patches are required for a successful outcome.</p>
References changed:
- 1. Kranz P, Gray L, Taylor J. CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension. AJNR Am J Neuroradiol. 2011;32(5):832-8. <a href="https://doi.org/10.3174/ajnr.A2384">doi:10.3174/ajnr.A2384</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21349964">Pubmed</a>
- 2. Agarwal V, Sreedher G, Rothfus W. Targeted CT-Guided Epidural Blood Patch for Treatment of Spontaneous Intracranial Hypotension Due to Calcified Intradural Thoracic Disc Herniation. Interv Neuroradiol. 2013;19(1):121-6. <a href="https://doi.org/10.1177/159101991301900118">doi:10.1177/159101991301900118</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23472734">Pubmed</a>
- 3. Gupta D, Amhaz H, Mazumdar A, Soskin V. Transient Compressive Lumbar Radiculopathy Following Post-Epidural Blood Patch. J Anaesthesiol Clin Pharmacol. 2014;30(1):112-4. <a href="https://doi.org/10.4103/0970-9185.125723">doi:10.4103/0970-9185.125723</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24574611">Pubmed</a>
- 4. Schievink W, Maya M, Louy C, Moser F, Tourje J. Diagnostic Criteria for Spontaneous Spinal CSF Leaks and Intracranial Hypotension. AJNR Am J Neuroradiol. 2008;29(5):853-6. <a href="https://doi.org/10.3174/ajnr.A0956">doi:10.3174/ajnr.A0956</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18258706">Pubmed</a>
- 5. John L. Atlee. Complications in Anesthesia. (2007) ISBN: 9781416022152 - <a href="http://books.google.com/books?vid=ISBN9781416022152">Google Books</a>
- 6. Chestnut DH, Wong CA, Tsen LC et-al. Chestnut's Obstetric Anesthesia: Principles and Practice (Chestnut, Chestnut's Obstetric Anesthesia: Principles and Practice). Saunders. ISBN:B00JBSPVHO. <a href="http://books.google.com/books?vid=ISBNB00JBSPVHO">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/B00JBSPVHO">Find it at Amazon</a><span class="auto"></span>
Tags changed:
- cases
Sections changed:
- Interventional Radiology
Systems changed:
- Spine
- Central Nervous System
- Interventional
- Musculoskeletal