Epidural blood patch

An epidural blood patch (EBP) is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture or epidural. The procedure can be used to relieve orthostatic headaches, most commonly post dural puncture headache (PDPH). The procedure carries the typical risks of any epidural procedure. They 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. 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. EBPs were first described by American anesthesiologist Turan Ozdil and surgeon James B Gormley around 1960. EBPs are an invasive procedure but are safe and effective—further intervention is sometimes necessary, and repeat patches can be administered until symptoms resolve. It is the 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. The procedure is not entirely benign—seven cases of arachnoiditis have been reported as a result of administration. EBPs are administered for treatment-related or spontaneous orthostatic headaches. The procedure is most often used to relieve PDPH following an epidural injection and lumbar puncture. Most PDPHs are self-limiting, so epidural blood patches are only used for people with moderate to severe cases who do not respond to conservative treatment. It is also used to treat spontaneous intracranial hypotension (SIH). EBP has been used to treat pseudomeningoceles and leaks around intrathecal pumps. For SIH, the same administration technique is used but at a different location with a different amount of blood injected.