autologous epidural blood patch

Indications

• CSF leakage not responding to conservative management
• intracranial hypotension (orthostatic headache)

Procedure

• venipucture: obtain 14-40 mL of autologous venous blood
• insert spinal needle into the epidural space
• inject blood slowly over minutes
• a second injection may be effective if the first injection fails
• although the 1st injection is usually successful, some patients may require up to 6 injections
• blood patches may be successful when delivered at the lumbar epidural space even when the CSF leak is at the level of the thoracic spine or cervical spine
• in refractory cases, CT-guided injection at the site of the CSF leak may be effective

Complications

• some patients develop radicular pain or back pain with more rapid injections

More general terms

• neurosurgery