Blood injected epidurally to resolve a cerebrospinal fluid leak
Epidural blood patch
Diagram of an epidural blood patch
ICD-10-PCS
G97.1
MeSH
D017217
[edit on Wikidata]
An epidural blood patch (EBP) is a surgical procedure that uses autologous blood, meaning the patient's own blood, in order to close one or many holes in the dura mater of the spinal cord, which occurred as a complication of a lumbar puncture or epidural placement.[1][2] The punctured dura causes cerebrospinal fluid leak (CSF leak).[1] The procedure can be used to relieve orthostatic headaches, most commonly post dural puncture headache (PDPH).
This procedure carries the typical risks of any epidural procedure. EBP are usually administered near the site of the cerebrospinal fluid leak (CSF leak), but in some cases the upper part of the spine is targeted.[3] An epidural needle is inserted into the epidural space like a traditional epidural procedure. The blood modulates the pressure of the CSF and forms a clot, sealing the leak.[4][5][6] EBPs were first described by American anesthesiologist Turan Ozdil and surgeon James B Gormley around 1960.[7]
EBPs are an invasive procedure but are safe and effective—further intervention is sometimes necessary, and repeat patches can be administered until symptoms resolve.[6][4][8] It is considered the gold standard treatment for PDPH. Common side effects include back pain and headache. Rebound intracranial hypertension in people with spontaneous intracranial hypotension (SIH) is common, and people with SIH may have less success with EBPs. While the procedure uses blood, it does not carry a significant infectious risk, even in immunocompromised people.[9] The procedure is not entirely benign—seven cases of arachnoiditis have been reported as a result of administration.[10]
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^Villani, Linda A.; Digre, Kathleen B.; Cortez, Melissa M.; Bokat, Christina; Rassner, Ulrich A.; Ozudogru, Seniha N. (2021-02-13). "Arachnoiditis, a complication of epidural blood patch for the treatment of low-pressure headache: A case report and systematic review". Headache. 61 (2): 244–252. doi:10.1111/head.14076. ISSN 1526-4610. PMID 33583044. S2CID 231926107.
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