Cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Most patients do not report any pain or discomfort during the procedure. Targeted ctguided epidural blood patch for treatment of spontaneous intracranial hypotension due to calcified intradural thoracic disc. Epidural blood patch is an iatrogenic epidural hematoma. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Procedural predictors of epidural blood patch efficacy in. The vertebral space where the ebp was performed is depicted in figure 2.
In this case, however, the paucity of contrast in the epidural space elsewhere is more suggestive that this is actually the site of the leak. Blind epidural blood patch for spontaneous intracranial. Spontaneous intracranial hypotension treated with a. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. After the blood is administered, it will clot and form a patch sealing the site and preventing csf from leaking over 95% of the time.
The blood clots, helping to patch punctures after a spinal tap procedure. On discussion with the patient, her beliefs as a jehovahs witness prevented her from receiving a blood patch in the traditional fashion. Independent of the leakage site, an ebp is usually applied at the lumbar level with varying success. Clinically, it is characterized by orthostatic headache and may respond well to epidural blood patch. An epidural blood patch is an outpatient procedure that involves drawing a small amount of blood from the patient, then injecting it into the epidural space. Xray photography to confirm the epidural infusion of contrast medium. We used ct myelography to detect the site of the dural leakage, then. The authors present two cases of intraventricular hemorrhage ivh believed to be a result of epidural blood patching. Intracranial subdural hematoma after epidural anesthesia.
The patient also received an epidural blood patch the next day with no improvement in the headache. Blood patch success with post lp leak spinal csf leak. Hi smc, i just had my second blood patch at stanford. Intracranial hypotension caused by cervical cerebrospinal. To put the blood patch in place, the anesthesiologist will.
Epidural blood patch has traditionally been performed in the lumbar area, with few cases reported in the thoracic and lower cervical spine 1, 3, 4. The leak was later treated by a ct guided blood patch. Spontaneous intracranial hypotension sih is a condition caused by spontaneous spinal cerebrospinal fluid csf leaks. The patient was subsequently referred for an anaesthetic opinion with a view to treatment using an epidural blood patch ebp. Spine images in a patient with csf leakage in and after ebp.
Epidural blood patch inpatient care what you need to know. Blood patch archives csf leak association cerebrospinal fluid. The autologous epidural blood patch ebp was first shown to be. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his sdh. This procedure is done to treat severe spinal headaches caused when an epidural, spinal needle or lumbar puncture accidentally punctures a hole in the outer membrane of the spinal cord causing a leak of spinal fluid. In this case the epidural blood patch is the treatment of choice. The classic manifestation of sih is an orthostatic headache, but other neurological symptoms may be present. Our initial assessment concluded that the diagnosis of sih was not in question. Blood patch procedure what is a blood patch procedure. Ctguided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension. Listing a study does not mean it has been evaluated by the u. An epidural blood patch is a procedure to treat a headache caused by leaking cerebrospinal suhreebrohspynuhl fluid csf. Predictors of the response to an epidural blood patch in.
An epidural blood patch is thought to be the most effective. Our latest factsheet comprises an example of a medical report for ct myelography and epidural blood patch carried out at duke university hospital. Epidural blood patch technique, recovery, and success rate. An epidural blood patch may also help reduce other spinal fluid leak symptoms. Targeted epidural blood patch under oarmguided stereotactic navigation in patients with intracranial hypotension associated with a spinal cerebrospinal fluid leak and ventral dural defect. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Intracranial hypotension is a rare cause of persistent headache mostly originating from a dural csf leak. T2weighted fatsaturated mri or ct myelography may demonstrate direct. Therefore we concluded the diagnosis as cervical csf leak leading to intracranial hypotension with postural symptoms. The patient showed complete relief from orthostatic headache on the same day.
If these conservative and pharmacologic strategies do not achieve a satisfactory improvement in a reasonable time, an interventional approach should be considered. The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. As with any procedure, there is a slight risk of infection. Cervical ct scanguided epidural blood patches for spontaneous. It is thought to be due to spontaneous spinal cerebrospinal fluid csf leaks, which probably have a multifactorial etiology. Ctguided epidural blood patching of directly observed or. Effectiveness of epidural blood patch in the management of. Anesthesiology was then consulted for placement of a blood patch.
Fluoroscopically guided epidural blood patch with subsequent spinal ct scans in the treatment of spontaneous cerebrospinal fluid hypovolemia. The leak was diagnosed by a dynamic computed tomography ctmyelography study followed by gadolinium enhanced magnetic resonance imagingmriscan. Failed blood patch csf leak spinal csf leak inspire. She would only accept a blood patch if a closed circuit was established between her circulation and the epidural. Cervical dural csf leak on mri and ct treated by blood patch. Epidural blood patch is a treatment option for patients with craniospinal. Ebp was attempted using fluoroscopic and then ct guidance. An epidural blood patch is a treatment for spinal headaches.
A blood patch is a medical procedure that is used to close cerebral spinal fluid csf leaks. Recovery is tough a lot of lower back pain headaches vomiting etc. This headache is often described as a headache like no other, being more severe when the patient is. Epidural blood patch was performed at the t1 to t2 level, the presumed location of the leak due to presence of a bone spur on ct and the large corresponding csf collection. The blood patches are planned, and the skin is marked for the ctguided procedure, which is performed concurrently with the ct myelography. Epidural patching medical clinical policy bulletins aetna. Choose 77003 fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures epidural, transforaminal epidural, subarachnoid, or sacroiliac joint, including neurolytic agent destruction and submit it with 62273 injection, epidural, of blood or clot patch. In the procedure, a doctor will take a blood sample from a patient and then inject that blood back into a hole in the epidural space. Conservative treatment serves as firstline therapy, but if it fails, a minimally invasive epidural blood patch ebp can lead to successful sealing of such a leak. We report the clinical and imaging presentation of a case of intracranial hypotension caused by spontaneous csf leak originating at the c2 level, treated by an epidural blood patch performed at the site of the leak.
Four patients, who received epidural blood patch to treat postdural puncture headache, were examined with computed tomography in order to demonstrate the distribution of the injected blood. The dural tear often occurs at the thoracic or cervical level. Watanabe k1, hashizume k, kawaguchi m, fujiwara a, sasaoka n, furuya h. Intraventricular hemorrhage after epidural blood patching. Twosite blind epidural blood patch versus targeted. Ctguided epidural blood patch for treatment of csf leak and. I had a similar situation like you did after a second lumbar tap for hydrocephalus i couldnt lift my leg etc. The patient then remained in the supine position for at least 2 hours. Spontaneous intracranial hypotension sih is an important cause of new daily persistent headache. Ct myelography for the planning and guidance of targeted. Targeted ctguided epidural blood patch for treatment of. A spinal headache may occur up to 5 days after the lumbar puncture. Twosite blind epidural blood patch ebp technique for a 42yearold woman with spontaneous intracranial hypotension ebps are placed at the c7t1 and t12l1 levels using 20 cc of autologous blood.
Epidural blood patch an overview sciencedirect topics. Ctguided percutaneous translaminar approach for blood. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Computed tomography ct myelography revealed csf leakage in the level of t3 vertebra. This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid csf pressure headache resulting from spontaneous csf leak via a tear in a cervical dural cuff.
This complication can happen after a spinal tap, an epidural for labor and delivery, or another procedure that requires a spinal puncture. Following the first ebp, 105 patients had relief of headache. After the procedure, the localization of the epidural autologous blood was confirmed by ct fig. A csf leak can occur when there is a tear or puncture in the dura the membrane that surrounds the brain and spinal cord that causes the watery protective fluid csf that circulates around these neurological structures to. Recovery time is short and patients can resume their normal activities. This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her. Epidural blood patch precare what you need to know. There was, however, some reluctance among the senior anaesthetic staff to perform an ebp for a number of reasons. If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. The procedure can be done blind or under fluoroscopic or ct guidance, and is. If a conservative treatment fails, a minimally invasive ebp can lead to a successful sealing of such a leak.
The first was a 71yearold woman who had new onset of nontraumatic ivh on computed tomography ct scan after undergoing an epidural blood patch ebp. A head ct performed on hospital day 3 showed a decrease in the size of the hematomas, and the patient was discharged on levetiracetam for seizure prophylaxis for 1 week. Targeted epidural blood patch at the site of presumed csf leak can be carried out in a safe and effective manner using ct fluoroscopic guidance. Pdf subdural hematoma after an epidural blood patch. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. Ctguided epidural blood patch for treatment of csf leak and pseudomeningocele following tethered cord release in a 3yearold author links open overlay. Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. Epidural blood patch ebp was performed for the treatment of severe postlumbar puncture cephalalgia in 118 young patients. Spontaneous intracranial hypotension treated with a targeted ct.1301 912 442 741 625 255 181 1217 877 1610 1562 1508 1308 164 1050 244 280 255 662 1666 785 817 1075 315 1299 45 812 696 1502 15 219 1407 721 786 360 319 487 35 754 845 1364 1227 645 779 553 1481 1359 1208 1161 724 714