Epidural Blood Patch as a Diagnostic and Therapeutic Intervention in Spontaneous Intracranial Hypotension: A Novel Approach to Management

Early and Delayed Rebound Intracranial Hypertension Following Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension: A Case Report

“…The mechanism of action of an EBP is not clear, but proposed mechanisms include an increase in intracranial CSF volume and pressure, plugging of the dural leak, and facilitation of rapid healing of the tear. The volumes of blood used in different studies have ranged from small (10 ml) to large (50 ml) amounts [5,8,11,12].…”

“…For patients who do not adequately respond to a conservative approach, injection of autologous blood into the spinal epidural space is the preferred invasive treatment. The success rate for each EBP varies from 30-70% for non-targeted patching, and up to 87% for targeted patching [2,5,6,9].…”

“…An epidural blood patch (EBP) with autologous blood is the most common procedure for spinal CSF leaks when conservative methods prove ineffective. It also functions as a diagnostic and therapeutic tool with response rates that vary from 30-90% [5,6]. If the patient is refractory to multiple EBPs, it is reasonable to explore the leak site by MRI, CT myelography, or cisternography and might lead to consideration of a targeted EBP.…”

“…The most common leak location is the thoracic spine, followed by the cervical spine, and less commonly the lumbar spine [5,6]. Without sustained improvement after targeted (to the site of the leak) and/or nontargeted lumbar EBPs, in cases where there is a clear leak, surgical intervention may be required [2,3].…”

Low-Pressure Hydrocephalus and Shunt Malfunction Following a Lumbar Puncture in an Adult Reversed by an Epidural Blood Patch

“…28,29 The indications for an epidural blood patch have become broader and now include spontaneous intracranial hypotension, post-lumbar puncture paradoxical herniation, treatment of cranial nerve dysfunction following lumbar puncture or spinal anesthesia, among others. 25,28,[30][31][32][33] Smalley et al 2 were the first to report an epidural blood patch for the management of post-lumbar puncture LPH in 2 children, but to this date this approach has not been reported in an adult.…”