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autologous epidural blood patch
Indications:
- CSF leakage not responding to conservative management
- intracranial hypotension (orthostatic headache)
Procedure:
- venipucture: obtain 14-40 mL of autologous venous blood
- insert spinal needle into the epidural space
- inject blood slowly over minutes
- a second injection may be effective if the first injection fails
- although the 1st injection is usually successful, some patients may require up to 6 injections
- blood patches may be successful when delivered at the lumbar epidural space even when the CSF leak is at the level of the thoracic spine or cervical spine
- in refractory cases, CT-guided injection at the site of the CSF leak may be effective
Complications:
- some patients develop radicular pain or back pain with more rapid injections
General
neurosurgery
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 18.
American College of Physicians, Philadelphia 2009, 2018.