Intraoperative use of cone-beam computed tomography for the safe epidural blood patch: Technical case report

BACKGROUND: Epidural blood patch (EBP) is a common method utilized to treat intracranial hypotension, and secondarily, to treat unintentional dural puncture. The authors propose an effective technique for correct epidural needle positioning during EBP using cone-beam computed tomography (CB-CT) images. CASE DESCRIPTION: A 31-year-old female underwent an EBP. Following confirmation of the spinal level of the cerebrospinal fluid leakage, the ideal trajectory for the proposed EBP was assessed from the entry point on the skin to the spinolaminar line under CB-CT imaging. The epidural needle was then gently advanced along the appropriate trajectory. At the 10 mm mark, behind the spinolaminar line, the inner needle was removed. This allowed for slow advancement of the outer needle until its tip reached the epidural space, and its location was confirmed by the “loss of resistance to the saline technique.” Using biplane epidurography, the spread of dye within the epidural space for appropriate localization was confirmed. In this case study, the patient’s postural headache immediately improved. CONCLUSION: Using the CB-CT technique described, a patient successfully underwent EBP without complications.