Circumferential Epidural Patch for Postdural Puncture Headache: A Technical Report.

A subset of postdural puncture headaches (PDPH) persist despite conventional epidural blood patches, leading to chronic symptoms and substantial disability. Dural punctures may involve not only the dorsal dural surface, which is covered by a standard interlaminar epidural blood patch (EBP), but also in some instances the ventral dural surface, which may not be covered by standard EBPs. This report describes the CT fluoroscopy-guided circumferential EBP, a technique that achieves 360° coverage of patching material around the thecal sac using combined ventral transforaminal and dorsal interlaminar injections. The procedural details for this technique are described, and the technical success and clinical results are reported for six patients with PDPH, four of whom had failed prior dorsal-only EBPs. Intraprocedural imaging confirmed complete circumferential patch coverage in all cases, and all six patients reported substantial or complete symptomatic resolution. These results establish the feasibility of CT fluoroscopy-guided circumferential EBP for PDPH.ABBREVIATIONS: EBP = epidural blood patch; PDPH = postdural puncture headache.