Epidural blood patch: A narrative review

Zetlaoui, Paul; Buchheit, Thomas Edward; Benhamou, Dan

doi:10.1016/j.accpm.2022.101138

Cited by 18 publications

(20 citation statements)

References 203 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients may present with classical symptoms/signs of intracranial hypotension (ICH) due to newly occurrent or recurrent CSF leaks/DT [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] ese symptoms typically include; postural headaches, nausea/vomiting, visual complaints/double vision, difficulty concentrating, lumbar radiculopathy/cauda equina syndromes, sphincter dysfunction, and/or sexual dysfunction. [2][3][4][5][6][7][8][9] CSF leaks/ DT are largely documented on thin-cut MR or Myelo-CT studies following prior epidural spinal injections (ESI), lumbar punctures (LP), spinal anesthesia (SA), spontaneous intracranial hypotension (SICH), or trauma due to surgery.…”

Section: Symptoms and Etiology Of Intracranial Hypotensionmentioning

confidence: 99%

“…[2,11,14] Primary or Recurrent Postoperative CSF Fistulas/DT Warranting Direct Surgical Repair e rates for primary intraoperative (3.0 -27%) and recurrent postoperative CSF leaks/DT (1.8 -17.6%) varies [Tables 1 and 2]. [3][4][5]7,8,11,13,15,16] (153/2024 patients) incidence of primary intraoperative DT (i.e. no history of prior surgery) vs. a much higher 15.9% for revision procedures (185/1159 patients); an additional 6 (1.8%) patients developed recurrent postoperative leaks that were successfully surgically repaired.…”

Section: Symptoms and Etiology Of Intracranial Hypotensionmentioning

confidence: 99%

“…For SICH, Myelo-CT and thin-cut MR studies documented that DT were effectively treated with ultrasound, fluoroscopy, and/or O-arm guided "targeted EBP" [Tables 1 and 2] [10,13,15,16] In Yoshida et 1]. [15] 1].…”

Section: Several Studies Documented Sich Were Effectively Treated Wit...mentioning

confidence: 99%

“…[10] Further, Zetaloui et al (2022) recommended using MR or doppler ultrasound after EBP to document/confirm the accuracy, efficacy, and/or adverse events following these procedures. [16] Adverse Events Resulting From Epidural Blood Patches (EBP) to Treat Post LP Dural Punctures…”

Section: Several Studies Documented Sich Were Effectively Treated Wit...mentioning

confidence: 99%

“…The rates for primary intraoperative (3.0 - 27%) and recurrent postoperative CSF leaks/DT (1.8 - 17.6%) varies [ Tables 1 and 2 ]. [ 3 - 5 , 7 , 8 , 11 , 13 , 15 , 16 ] Khan et al . (2006) noted a 7.6% (153/2024 patients) incidence of primary intraoperative DT (i.e.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Perspective: Early direct repair of recurrent postoperative cerebrospinal (CSF) fluid leaks: No good evidence epidural blood patches (EBP) work

Epstein¹,

Agulnick

2023

Surgical Neurology International

View full text Add to dashboard Cite

Background: “Targeted” epidural blood patches (EBP)” successfully treat “focal dural tears (DT)” diagnosed on thin-cut MR or Myelo-CT studies. These DT are largely attributed to; epidural steroid injections (ESI), lumbar punctures (LP), spinal anesthesia (SA), or spontaneous intracranial hypotension (SICH). Here we asked whether “targeted EBP” could similarly treat MR/Myelo-CT documented recurrent post-surgical CSF leaks/DT that have classically been effectively managed with direct surgical repair. Methods: Utilizing ultrasound, fluoroscopy, or O-arm guidance, “targeted EBP” effectively manage “focal DT” attributed to ESI, LP, SA, or SICH. Here we reviewed the literature to determine whether similar “targeted EBP” could effectively manage recurrent postoperative CSF leaks/DT. Results: We were only able to identify 3 studies involving just 20 patients that attempted to utilize EBP to control postoperative CSF fistulas/DT. EBP controlled CSF fistulas/DT in 6 patients in the first study, and 9 of 10 patients (i.e. 90%: 2/2 cervical; 7/8 lumbar) in the second study. However, in the third study, 3 (60%) of 5 EBP failed to avert recurrent CSF leaks/DT in 4 patients (i.e. 1 cervical patient (2 EBP failed attempts), 3 lumbar patients (1 failed EBP)). Conclusion: Early direct surgical repair of recurrent postoperative spinal CSF leaks/DT remains the treatment of choice. Our literature review revealed 3 underpowered studies including just 20 patients where 20% of EBP failed to control recurrent postoperative fistulas (range of failure from 0-60% per study). Although there are likely other studies we failed to identify in this review, they too are likely insufficiently powered to document significant efficacy for performing EBP over direct surgical repair for recurrent postoperative CSF leaks/DT.

show abstract