Application of cervical epidural blood patch for spontaneous cerebrospinal fluid leaks: Two case reports
Sebnem Rumeli1
, Mesut Bakır1, Guldane Turhan2, Mehmet Ertargın1, Mehmet Ridvan Yalin3
1Department of Anesthesiology and Reanimation, Division of Pain Medicine, Mersin University Faculty of Medicine, Mersin, Türkiye
2Pain Clinic, Mersin City Training and Research Hospital, Mersin, Türkiye
3Pain Clinic, İskenderun State Hospital, Hatay, Türkiye
Keywords: Cervical epidural blood patch, fluoroscopic guidance, spontaneous intracranial hypotension.
Abstract
Spontaneous cerebrospinal fluid (CSF) leaks are uncommon but significant causes of orthostatic headaches, often resulting from dural injuries. Although lumbar epidural blood patches (EBPs) are commonly used to treat such leaks, cervical EBPs are rarely performed due to the higher risk of complications, including spinal cord injury. This case series presents two patients with spontaneous cervical CSF leaks successfully treated with cervical EBPs under fluoroscopic guidance. The first case involved a 24-year-old female who presented with a two-month history of severe orthostatic headaches and tinnitus and a Visual Analog Scale (VAS) score of 8. After a cervical EBP with 3 mL of autologous blood, her symptoms resolved. The second case describes a 55-year-old male with a history of radiotherapy who presented with a VAS score of 10 and a four-month history of orthostatic headaches. A cervical EBP using a total of 6 mL of blood led to complete symptom resolution. Both cases highlight the efficacy and safety of cervical EBPs when performed with careful imaging guidance and minimal blood volumes. These findings suggest that this approach should be considered in cases of refractory cervical CSF leaks.
Cite this article as: Rumeli S, Bakır M, Turhan G, Ertargın M, Yalin MR. Application of cervical epidural blood patch for spontaneous cerebrospinal fluid leaks: Two case reports. Agri 2026;38(4):298-301. doi: 10.5606/agri.2026.81.
Ş.R., M.B.: Contributed to the idea and concept of the study, clinical management of the cases, data collection and/or processing, literature review, and writing of the manuscript; G.T., M.E., M.R.Y.: Contributed to data collection and/or processing, literature review, and critical review of the manuscript; Ş.R., M.B.: Provided control and supervision throughout the study and critically reviewed the manuscript. All authors read and approved the final version of the manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.
The authors received no financial support for the research and/or authorship of this article.
Data Sharing Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.