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Related Experiment Videos

Epidural blood patch illustrated by CT-epidurography

H Djurhuus1, M Rasmussen, E H Jensen

  • 1Department of Anaesthesia, Landssjúkrahúsith Tórshavn, Faroe Islands.

Acta Anaesthesiologica Scandinavica
|July 1, 1995
PubMed
Summary

Epidural blood patches for postdural puncture headaches were visualized using computed tomography. Adding contrast media to blood effectively demonstrated its distribution in the epidural space, showing affinity to the dural sac.

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Area of Science:

  • Radiology
  • Anesthesiology
  • Neurosurgery

Background:

  • Postdural puncture headache is a complication of dural puncture.
  • Epidural blood patch (EBP) is a common treatment for postdural puncture headache.
  • The exact distribution and mechanism of EBP are not fully understood.

Purpose of the Study:

  • To visualize the distribution of blood injected during an epidural blood patch.
  • To assess the spatial spread and relationship of the blood to the epidural anatomy.
  • To evaluate the space-filling effect of the epidural blood patch.

Main Methods:

  • Computed tomography (CT) was used to examine four patients post-EBP.
  • A mixture of autologous blood (18 ml) and contrast agent (2 ml Iohexol 180 mg J/ml) was injected.

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  • CT imaging focused on demonstrating the distribution of the blood-contrast mixture in the epidural space.

    • Main Results:

    • Blood alone was not identifiable on CT.
    • The addition of contrast agent allowed excellent visualization of blood distribution.
    • The blood-contrast mixture spread cranio-caudally over 7-14 spinal segments.
    • The injected blood showed a strong affinity for the dural sac.
    • No evidence supporting a significant space-filling effect of the EBP was observed.

    Conclusions:

    • Contrast-enhanced CT is effective in demonstrating epidural blood distribution after EBP.
    • The injected blood primarily localizes around the dural sac.
    • The mechanism of EBP relief may not solely be due to a simple space-filling effect.