National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Epidural Blood Patch Robert E. Author Information Authors Robert E. Continuing Education Activity An epidural blood patch EBP is a procedure in which a small volume of autologous blood is injected into a patient's epidural space to stop a leak of cerebrospinal fluid CSF. Introduction An epidural blood patch EBP is a procedure in which a small volume of autologous blood is injected into a patient's epidural space to stop a leak of cerebrospinal fluid CSF.
Anatomy and Physiology The epidural space is bounded by the dural meninges anteriorly, the ligamentum flavum posteriorly and the sides of the vertebral walls laterally. Equipment Equipment required for EBP includes a standard epidural kit and an gauge or gauge angiocatheter from which to draw autologous blood in a sterile fashion. Personnel Although EBP can be performed by a single operator, it usually requires a second operator for a sterile blood draw and, possibly, a third assistant to help with patient positioning.
Preparation Following an explanation of the procedure and obtaining informed consent, the patient is placed in a lateral or seated position. Technique The epidural space is identified in the standard fashion using loss-of-resistance to air or saline. Enhancing Healthcare Team Outcomes Once PDPH has developed, healthcare workers including nurse practitioners, physician assistants, and primary care physicians should educate the patients.
Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension. Reg Anesth Pain Med. Post-dural puncture headache. Minerva Anestesiol.
Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study. Int J Obstet Anesth. The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage.
Eur Radiol. Lumbar epidural blood patch: effectiveness on orthostatic headache and MRI predictive factors in consecutive patients affected by spontaneous intracranial hypotension.
J Neurosurg. Clinical effect of the proximity of epidural blood patch injection to the leakage site in spontaneous intracranial hypotension. Br J Neurosurg. Impact of spinal needle type on postdural puncture headache among women undergoing Cesarean section surgery under spinal anesthesia: A meta-analysis.
J Evid Based Med. Anesthetic approach to postdural puncture headache in the peripartum period: An Israeli national survey. Acta Anaesthesiol Scand. Two-site blind epidural blood patch versus targeted epidural blood patch in spontaneous intracranial hypotension. J Clin Neurosci. Epidural Blood Patch. In: StatPearls [Internet]. In this Page. Related information. PubMed Links to PubMed.
A favorable response to an epidural blood patch supports the diagnosis of a leak but often lacks durability.
While restrictions after an EBP are individualized, it is typical for physicians to recommend avoidance of bending, lifting, twisting, and straining valsalva for about weeks. Typical radiology suite where an EBP might be performed. Reproduced with permission from Wouter I. Schievink, MD. Fibrin glue sealant is a biologic adhesive, comprised of a pooled blood product that has been treated with a two-step process to reduce the risk of viral transmission.
Fibrin glue sealant can occasionally result in allergic or anaphylactic reactions, but pre-treatment with medication reduces that risk. This procedure is most often performed by neuroradiologists with imaging guidance and intravenous sedation to target specific known or suspected leak locations. Anesthesiologists and other clinicians also perform this procedure.
It may be used in isolation or in combination with whole blood. The findings and interpretation of spinal imaging is of critical importance in surgical planning and outcomes. Surgical repairs are often less technically straightforward than might be anticipated, due to frequently noted abnormal dura and the variety of anatomic leak types and locations. The specific approach is tailored to the type and location of the leak and to the individual patient.
Dural defect repaired Reproduced with permission from Wouter I. While spinal CSF leaks are often misdiagnosed, Duke neuroradiologists are among the few experts in the country skilled at finding and repairing spinal CSF leaks.
We have extensive experience treating CSF leaks, even in people who have not had success with other treatments. Cerebrospinal fluid can leak out from around the spine due to a hole in the dura, the dense tissue that surrounds the brain and spine. The hole can result from:. The tear and resulting leak of cerebrospinal fluid can cause you to lose the protective cushion of fluid around the brain and spinal cord.
Low cerebrospinal fluid pressure leads to chronic headaches and other debilitating symptoms including:. If you are experiencing these symptoms and have not found relief through standard medical treatments, consider evaluation for a spinal CSF leak.
Seek Care from a Neuroradiologist Duke neuroradiologists specialize in using high-resolution CT, MRI, and fluoroscopic imaging to diagnose and treat CSF leaks and other conditions that affect the brain, spine, head, and neck.
Duke neuroradiologists perform a physical exam and conduct a thorough medical history to obtain more information about your symptoms. A contrast dye injected intravenously via an IV helps highlight these abnormalities on the scan. In a small percentage of people, additional imaging is needed. CT Myelogram or Dynamic Myelogram Through a lumbar puncture and with imaging guidance, a contrast dye is injected into your spinal fluid via a tiny needle. Then your entire spine is imaged.
The dye helps identify leaking fluid and pinpoint the site of a CSF leak. Depending on the cause of the leak, one of these customized treatments may be recommended. Recovery can take several weeks. After your procedure, our team will contact you often to monitor your progress.
Blood Patch Your own blood or, in some cases, a type of surgical glue is used to create a patch that seals the leak.
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