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Epidural Blood Patch

An epidural blood patch is an injection of autologous blood into the epidural space to close a cerebrospinal fluid (CSF) leak.

What is a CSF Leak?

A CSF leak is caused by a tear or puncture in the dura, which is the membrane that surrounds the brain and spinal cord, leading to a leak of protective fluid (CSF) that surrounds these neurological structures.

A cranial CSF leak occurs in the head, while a spinal CSF leak occurs around the spine.

Symptoms of a CSF Leak

A CSF leak may lead to the following symptoms:

Headaches which may worsen when standing and alleviate when lying down (sometimes called spinal headaches)

Woman experiencing headache and needing epidural blood patch

Nurse speaking to patient after successful epidural blood patch

Clear fluid coming from the nose or ear
Blurred vision
Tinnitus
Meningitis
Nausea and vomiting
Sound sensitivity
Difficulty with balance
Changes in sense of smell

What Causes a CSF Leak?

A CSF leak may be caused by:

Accidentally piercing the dura with a needle during spinal anesthesia or lumbar puncture

Brain or spinal injury during a traumatic accident
Complication of sinus, brain, or spinal surgery
High pressure hydrocephalus
Other unknown causes

Before The Procedure

Patients may be given a sedative before the procedure to make them feel more comfortable. If so, they might be instructed not to eat or drink for a period of time before the scheduled blood patch. The sedative is administered to help patients relax without putting them to sleep. Patients are able to eat as soon as their procedure is finished.

What to Expect During an Epidural Blood Patch

A nurse will draw blood from a vein in the patient’s arm, around 15-30 milliliters. The blood will be used to patch the CSF leak.

The doctor may use medical imaging such as fluoroscopy or ultrasound to guide the needle into the correct location near the spine. The exact location will depend on where the fluid is leaking. Injecting blood into the epidural space will lead to the blood clotting over the CSF leak and sealing it closed.

After the procedure, patients may be instructed to lay flat for a little while. Many patients feel better almost immediately after the procedure.

Patients may need to limit certain activities for up to a month. These activities may include:

Heavy lifting
Bending
Twisting
Straining
Soaking in a hot tub or pool to avoid infection at the injection site (Showering is permissible and shouldn’t cause any side effects)

Patients who were given sedating medication to help them relax should refrain from driving and other activities that require alertness, good judgment, coordination, or balance for the rest of the day.

After The Procedure

Patients may experience a range of complications after receiving a blood patch; these may include:

Back pain
Bruising or redness at the injection site
Infections
New CSF leaks
Allergic reactions to medications given during the procedure

An epidural blood patch has a 90% effectiveness rate. If the first blood patch is unsuccessful, a second blood patch may be done. A second blood patch has a 95% success rate.

Patients who don’t benefit from a blood patch may need to undergo surgery.