Epidural blood patch

Dr Henry Knipe et al.

Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The procedure can be done blind or under fluoroscopic or CT guidance, and is performed predominantly by radiologists and anesthesiologists. 

  • craniospinal hypotension
  • post lumbar puncture headache
  • allergy to any of the planned medications
  • local or systemic infection

Epidural blood patches can be targeted (i.e. preprocedural imaging has demonstrated the site of CSF leak) or non-targeted 2.

Accessing the spinal epidural space can be done under fluoroscopy or CT, and is essentially identical to one described in the article on lumbar interlaminar epidural injection.

The difference is that the patient has a sterile cannulation prior to, and then the patient's own blood is withdrawn and injected. The volume can be low (2-3 mL) or high (10-20 mL), and can be mixed with contrast to outline the epidural space. 

Complications include 3,5:

The success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypotension and 90-99% for post lumbar puncture headache. In successful procedures, the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse 1,4,5. Sometimes multiple blood patches are required for a successful outcome.

Interventional procedures
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rID: 45899
Tag: cases
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Cases and figures

  • Case 1: fluoroscopic guidance
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  • Case 2: CT-guided epidural blood patch at C1/2 level
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