Epidural blood patch: A study on an experimental model

Abstract

Aim

Epidural blood patch has been used to treat spinal headache with varying success. An experimental model was designed to ascertain whether an epidural blood patch can be used to seal the needle puncture sites in dural repair.

Materials and Methods

Bovine dura was secured to the lower end of an open-ended calibrated plastic cylinder. Multiple interrupted stitches were applied over a 02 cm length of the dura without any incision. The cylinder was filled with colored saline gradually with the dura placed in a dependent position. Height of the water column at which sutured dura leaked was recorded. A layer of fresh blood was laid over the dura and allowed to clot. The test was repeated and the hydrostatic pressure at which leak took place was noted again. The test was repeated three times. Similar studies were done with two specimens with 02-cm dural incisions repaired with interrupted stitches of 4-0 silk in one specimen and 4-0 prolene in another, and three specimens with 3-mm unsutured dural rent in one and dural punctures made with 23-G and 26-G spinal needles in the other two.

Results

All the dural preparations leaked, at a very low hydrostatic pressure (<30 mm of H₂O). By covering the needle puncture sites with clotted blood, a watertight closure could be achieved, that can withstand a much higher hydrostatic pressure (mean of 180 mm of H₂O).

Conclusion

The experimental findings indicate that an epidural blood patch does enhance the ability of a dural closure to prevent a leak; however, its utility in clinical setting is questionable.

Key words

Epidural blood patch - experimental model - water-tight dural closure

• References

• 1 Sengupta SK. Watertight dural closure! An in vitro study to explore the myth. Indian J Neurosurg 2013; 2: 31-34
• 2 Megyesi JF, Ranger A, MacDonald W, Del Maestro RF. Suturing technique and the integrity of dural closures: An in vitro study. Neurosurgery 2004; 55: 950-955
• 3 Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R. et al Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 2009; 18: 1169-1174
• 4 Ghaleb A, Khorasani A, Mangar D. Post-dural puncture headache. Int J Gen Med 2012; 5: 45-51
• 5 Ozisik PA, Inci S, Soylemezoglu F, Orhan H, Ozgen T. Comparative dural closure techniques: A safety study in rats. Surg Neurol 2006; 65: 42-47
• 6 Keener EB. An experimental study of reactions of the dura mater to wounding and loss of substance. J Neurosurg 1959; 16: 424-447