Large volume epidural blood patch

Background and purpose: Spontaneous intracranial hypotension can be a therapeutic challenge to the treating physician. In this study, we present our experience with the administration of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site.

Materials and methods: A retrospective review was conducted of patients with spontaneous intracranial hypotension who underwent a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site from to In addition, our procedure may improve outcomes in patients who are refractory to traditional techniques. Our procedure provides the treating physician with an additional technique for this challenging pathology and may be technically less challenging with practice than is site-directed epidural blood patch in the thoracic and cervical spine.

Our experience is limited by the small cohort size and retrospective nature. In addition, our average follow-up was relatively short at 2. Future studies should include larger patient cohorts and longer follow-up periods. Our experience supports the use of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for the treatment of SIH, where no definite or multiple CSF leak sites are identified. Additionally, our results indicate a role for this procedure in SIH, which is refractory to traditional directed epidural patch procedures.

Future studies should evaluate outcomes in larger patient populations with a particular focus on outcomes in patients who have failed prior lumbar epidural puncture procedures or leak-site-directed procedures. Disclosures: Aditya S. National Center for Biotechnology Information , U. Griauzde , a J. Gemmete , a, b, c N. Chaudhary , a, b T. Wilson , b and A. Pandey b. Griauzde a From the Departments of Radiology J. Find articles by J. Gemmete a From the Departments of Radiology J.

Chaudhary a From the Departments of Radiology J. Find articles by N. Wilson b Neurosurgery J. Find articles by T. Pandey b Neurosurgery J. Find articles by A. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Please address correspondence to Joseph J.

Received Jan 2; Accepted Feb This article has been cited by other articles in PMC. Materials and Methods This study was approved by the institutional review board at the University of Michigan.

Table 1: Case characteristics. Open in a separate window. Table 2: Multisite epidural blood patch procedures and outcomes a.

Patient No. Procedure Patients were brought to the angiography suite and placed prone. Fig 1. Fig 2. Results Nine patients were identified. Fig 3. Fig 4. Discussion In this study, we evaluated our experience with administration of a large-volume blood patch to multiple sites in the epidural space by using a single-catheter access site for the treatment of spontaneous intracranial hypotension.

Conclusions Our experience supports the use of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site for the treatment of SIH, where no definite or multiple CSF leak sites are identified. Footnotes Disclosures: Aditya S. A novel technique of multiple-site epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia.

Intracranial hypotension syndrome: a comprehensive review. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology ; 55 —27 [ PubMed ] [ Google Scholar ]. Intracranial hypotension presenting with severe encephalopathy: case report. Peng PW. Intracranial hypotension with severe neurological symptoms resolved by epidural blood patch. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. Spontaneous intracranial hypotension: report of four cases and review of the literature.

Neuroradiology ; 40 —43 [ PubMed ] [ Google Scholar ]. Headache and intracranial hypotension: neuroradiological findings. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.

Early epidural blood patch in spontaneous intracranial hypotension. Neurology ; 63 —51 [ PubMed ] [ Google Scholar ]. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period.

Methods: Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 12 women; mean age, Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively.