Expanding epidural patching techniques for spinal csf leak. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. We sought to evaluate the efficacy of ctguided blood patching of observed or potential csf leaks in spontaneous intracranial hypotension. Epidural blood patch definition of epidural blood patch. Concurrently, the postural headache and neck pain continued to hamper the patients ability to ambulate such that, on day seven postcaesarean and dural puncture, an epidural blood patch was performed injecting 38 ml of blood without sequelae. Epidural blood patch ebp is the definitive treatment for low cerebrospinal fluid pressure csf. Effectiveness of epidural blood patch in the management of. Technic of insertion and complications of transpedicular. Epidural blood patch an overview sciencedirect topics. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. The volume injected displaces cerebrospinal fluid csf from the lumbar csf space into the area surrounding the brain, often yielding immediate. All structured data from the file and property namespaces is available under the creative commons cc0 license. Olsen ks 1987 epidural blood patch in the treatment of postlumbar.
Efficacy of epidural blood patch with fibrin glue additive. Epidural blood patch treatment of spontaneous intracranial hypotension arising from ventral csf leaks can be difficult secondary to challenges in achieving ventral spread of patching material. The use of fluoroscopy permits the targeting of the site. When compared with epidural blood patch the initial benefit of the saline patch is accepted to be more transient in adults. She came back on friday, so one of my partners, who. An epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. Dural puncture cannot cause any brain damage unless there is very high csf cerebrospinal fluid pressure inside the skull increased icp intracranial pressure, in which case the skull contents can herniate outside the skull through. If the symptoms are severe, epidural blood patch may be. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture.
Files are available under licenses specified on their description page. Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The original epidural site was l3l4 so i put 15 ml of blood at l4l5. The authors present two cases of intraventricular hemorrhage ivh believed to be a result of epidural blood patching. An epidural blood patch is a treatment method where a blood sample is taken from a patient and then injected into the epidural space shortly thereafter. An epidural blood patch uses a small amount of blood to create a seal. Under fluoroscopic guidance a spinal needle was advanced to the epidural space at l23, and position confirmed with the injection of 5 ml omnipaque 240. A small piece of material affixed to another, larger piece to conceal, reinforce, or repair a worn area, hole, or tear. Epidural blood patch inpatient care what you need to know.
An epidural blood patch may also help reduce other spinal fluid leak. Ctguided blood patching has been described but has not been evaluated in larger case series. This is a headache that is worse when the person is standing up and better when he or she is lying down. Efficacy of the epidural blood patch for the treatment of. Its mechanisms of action are thought to involve increased intracranial csf pressure due to mass effect and sealing of the dural puncture site with fibrin clot fig.
Optimal diagnosis and management of spontaneous intracranial hypotension remains uncertain. An epidural blood patch is a surgical procedure that uses autologous blood in order to close. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Epidural blood patch was conducted by experienced staff anesthesiologists, during strict surgical aseptic conditions, on a patient in a sitting position with the legs dependent. Technique, timing and administration practice pamela flood, md stanford university sol shnider 2018. Dural puncture post dural puncture headache epidural blood patch. P1101 spinaler epiduraler blutpatch zur behandlung einer spontanen. Duraperforation postpunktioneller kopfschmerz epiduraler blutpatch. But in children the validity of this topic is not yet known. Intraventricular hemorrhage after epidural blood patching. Rarely, after a lumbar puncture, a patient will develop a postlumbar puncture headache. An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture.
The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. International journal of obstetric anesthesia 2001. Myelographic techniques for the detection of spinal csf leaks. Epidural blood patch myths and legends springerlink. Pdph has typical features of a postural headache that is worsened by standing and relieved by lying down. The first theory suggests that the autologous blood injected in the epidural space forms a clot, which adheres to the dura mater and directly patches the hole. The technique for the ebp is the same as used for epidural steroid injection except that autologous unclotted blood is injected. Kenneth nelson discusses post dural puncture headache and epidural blood patch at the 2012 sol shnider meeting in san francisco. An audit of epidural blood patch after accidental dural puncture with a tuohy needle in obstetric patients. Post dural puncture headache and epidural blood patch on vimeo. Epidural blood patch complications answers on healthtap. Duraperforationpostpunktioneller kopfschmerzprophylaxeund.
The goal of the epidural blood patch is to treat the symptoms, typically headache, related to cerebrospinal fluid leaks of any cause. Postdural puncture headache and epidural blood patch use in elderly patients. Liquorpunktion dura mater nadeln koffein epiduraler blutpatch. The lumbar epidural space was located using a 17gauge vygon, ecouen, france or 18gauge portex, hythe kent, united kingdom tuohy needle, by the lossofresistance technique with fluid. Approximately 1520 mls of blood is taken from a vein in the patients arm and subsequently injected into the epidural space in the spine at the site of the spinal fluid leak. Two theories have been proposed to explain ebp efficiency in the treatment of pdph4,5,11. The use of thin, atraumatic needles and special puncture techniques e. The purpose of this study was to determine the technical success rates and safety profile of direct needle placement into the ventral epidural space via. Pdph is initially treated conservatively with increased fluid and caffeine intake and analgesics. Injection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid csf leaks and subsequent intracranial hypotension has recently been described. Epidural saline patch has been used several times and the effectiveness of the application has been reported in adult patients. Epidural blood patch technique, recovery, and success rate. This method is commonly used to treat patients with spinal headaches. Ctguided epidural blood patching of directly observed or.
Please tell me truth about your experience with the epidural blood patch. She came back to the er on wednesday with a post dural puncture headache. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique. These investigators prospectively studied 504 patients who underwent ebp over a 12year period at a paris hospital.
These headaches occur from a lumbar puncture that subsequently led to a cerebrospinal fluid leak. Weiler hospital of the albert einstein college of medicine2 introduction. Paech, fanzca, dm professor and chair of obstetric anaesthesia the school of medicine and pharmacology, the university of western australia, perth, western australia. Prevention is key but an epidural blood patch is standard treatment in postdural puncture headache. Headaches due to low csf pressure are stereotypically orthostatic in character with exacerbation in the upright position and relative improvement while supine. Epidural blood patch ebp, in which autologous blood is injected into the dural space, is advocated for severe or refractory cases. In this case the epidural blood patch is the treatment of choice. 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. An epidural blood patch is a procedure that removes a small amount of. I was recently diagnosed with pseudotumor cerebri via lp opening pressure 24mm hg i then got a spinal headache approx. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Epidural blood patch ebp is currently the gold standard for pdph treatment, with a success rate ranging from 90% to 99%. There are reports on epidural blood patch in jehovahs witness patients using a closed system which allows blood collection and epidural injection without loss of continuity.
1487 1494 569 374 21 577 818 691 1414 1246 923 26 493 201 7 914 489 860 785 990 1059 1586 1461 406 899 332 53 554 72 1383 277 228 1431