Anatomy For administration of an<unk>  due to PDPH, the level of prior epidural puncture is targeted;<unk>  injected for the most part spreads cranially. For SIH with unidentified leakage spots, L2 and L3 are targeted initially. Insertion For<unk> s, autologous<unk>  is drawn from a peripheral vein; the procedure uses a typical epidural needle. 20 mL of<unk>  is recommended for<unk> s, though injection should stop if not tolerated by the patient. This amount of<unk>  is also recommended for people in obstetrics. Targeted<unk>  is performed under real-time fluoroscopy if the location of the CSF leak is known. This fluoroscopic approach is standard, but with cases of SIH two-site blind injection has similar outcomes. No randomized clinical trials have been conducted for this due to the rarity of SIH. CT scanning can also be used.<unk>  from<unk> s is spread throughout several segments within the epidural space, so it does not need to be injected at the same level as the puncture. For treatment of SIH, medication with acetazolamide before an<unk>  and administration in the Trendelenburg position is effective. Mechanism When an<unk>  is administered a mass effect occurs which compresses the subarachnoid space, thereby increasing and modulating the pressure of the CSF, which translates intracranially.<unk>  maintains a pressures surge for a longer time than crystalloid fluids. Simultaneously, an "epidural plug" is formed as a result of clot formation; the clot adheres to the thecal sac, potentially becoming a permanent plug. After about half a day the mass effect stops, and a mature clot is left.
Epidural blood patch
Epidural steroid injection
Microvascular decompression
Lumbar–peritoneal shunt
Epidural administration
Intrathecal pump
Spinal decompression
Craniotomy