Epidural Blood Patch

Patients experiencing symptoms of a cerebrospinal fluid (CSF) leak may need an epidural blood patch, or an injection of autologous blood into the epidural space to close the leak.

What is a CSF Leak?

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

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

Symptoms of a CSF Leak

Physician looking at screen during epidural blood patch procedure

Scientist holding vial of cerebrospinal fluid

Patients with a CSF leak may experience the following symptoms:

Tinnitus
Meningitis
Blurred vision
Sound sensitivity
Nausea and vomiting
Difficulty with balance
Changes in sense of smell
Clear fluid coming from the nose or ear
Headaches which may worsen when standing and alleviate when lying down (sometimes called spinal headaches)

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Potential Causes of a CSF Leak

A CSF leak may be caused by:

High pressure hydrocephalus
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
Other unknown causes

What to Expect Before The Procedure

Before the procedure, patients may be given a sedative to make them

Woman with headache, needing epidural blood patch for CSF leak

feel more comfortable. If so, they might be instructed not to eat or drink for a period of time leading up to the scheduled procedure. The sedative will help patients relax without putting them to sleep. Patients are allowed to eat as soon as the epidural blood patch procedure is finished.

What to Expect During The Procedure

The procedure will begin with a nurse drawing blood from a vein in the patient’s arm, around 15-30 milliliters. The blood will be used to patch the CSF leak in the patient’s back or neck.

The doctor will then use medical imaging, such as fluoroscopy or ultrasound, to guide the needle into the correct location near the spine. The exact location of the injection will depend on where the fluid is leaking. Once the blood is injected into the epidural space, a blood clot will form over the CSF leak and seal it closed.

After the procedure, patients may need to lay flat while the injected blood clots. Many patients will feel better almost immediately after the procedure.
Certain activities may need to be limited for up to a month. These activities may include:

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

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

After The Procedure

A blood patch may cause the following complications:

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

An epidural blood patch is usually successful. 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 experience positive results from a blood patch may need to undergo surgery.