français

TREATMENT                                                                              

Reviewed by Dr. Howard Meng, MD, FRCPC

Page last updated: May 2026       

 

The treatment approach should be guided by the type and location of the leak, as determined through the diagnostic workup.

Strategies for Conservative Management of Spontaneous Spinal CSF leak(s)/SIH

Conservative management is usually not very effective. However, case reports in the literature indicate that these measures can be helpful for some patients.

Some strategies for conservative management/treatment of a spinal CSF leak are:

  • Bedrest in a horizontal/flat position for 24 to 72 hours.

  • Elevating the foot of the bed (Trendelenburg position)

  • Hydration: Ensure proper hydration to maintain fluid balance.

  • Caffeine: Caffeine is known for stimulating CSF production and therefore help with symptom management. Caffeine pills are generally used for ease of consumption.

  • Increasing sodium intake temporarily

  • Abdominal binder

For nausea

  • Ginger products

For pain

  • Medications such as Ibuprofen, Acetaminophen, and others

  • Cold compress on the head

 

Epidural Blood Patches

 

  • Blind Epidural Blood Patch

This type of patch is referred to as a “blind” or ”non-targeted” or “non-directed” epidural blood patch (EBP) because the procedure involves the injection of the patient’s own blood into the spinal epidural space without knowledge of the level of the site of the leak.  Experts believe that, through this approach, the clotting factors in the blood can seal the leak.

shutterstock_328972475.jpg

If the initial non-targeted EBP is unsuccessful, a second or third, larger-volume EBP is sometimes considered before proceeding with localization of the leak and directed EBPs. A blood patch is more effective if directed to the site of the identified leak.  However, it is usually worthwhile to try the non-targeted patches first because they will be effective in some patients, may provide partial relief in others, and may avoid the need for expensive or invasive testing in those who do have success.

  • Targeted Epidural Blood Patch

    An epidural blood patch given at the site of the leak is more effective than one given at a distant site.

    If the leak site or potential leak site is identified, targeted or directed epidural blood patches (sometimes also with placement of fibrin sealant (glue) may alleviate the patient’s symptoms. This procedure is performed with imaging guidance (fluoroscopy, CT, or sometimes ultrasound), depending on the site, complexity, and resources available at the center.

 

Transvenous Embolization

In cases where spinal CSF leak is caused by a CSF-venous fistula, this can be treated by a minimally invasive procedure called transvenous embolization. A thin catheter is introduced, typically through a vein in the groin and carefully navigated through the venous system to the specific vein feeding the fistula. Once precisely positioned, an embolic agent is delivered to occlude the vein and permanently close the abnormal connection. 

 

Surgery

Surgery may be considered when the site of leak is identified, and less invasive procedures (epidural blood patch and/or transvenous embolization) have failed.

Key Notes

  • Medications and nerve blocks often used for migraine headaches may be ineffective or partially effective for the headache associated with spinal CSF leaks.

  • Most patients who have a spinal CSF leak may require more than one EBP; in fact, they may require several to fix their leak(s).  If a first blood patch does not fix the leak, do not become hopeless.

  • The effectiveness of epidural blood patches varies depending on the type of spinal CSF leak. For example, in CSF-venous fistulas (Type 3), epidural blood patches are generally not effective because the CSF drains into the venous system rather than collecting in the epidural space. Patients with CSF-venous fistulas typically need surgical ligation, transvenous embolization, or CT-guided fibrin glue injection. This is why accurate diagnosis and leak type identification are so important.         

  • An early blood patch can still be valuable even when the exact type of leak is not yet known. A positive response (even if temporary) may support the diagnosis of a spinal CSF leak and helps guide further workup. Research also suggests that in some cases, the improvement from a blood patch may be due to a temporary "tamponade" effect rather than permanent sealing, which may explain why symptoms sometimes return.

  • “Patients should remain flat as much as possible for 24 hours, up to three days (if possible) after an epidural blood patch procedure to help ensure its success.” See AFTER CARE.

Recorded video from the 2nd Canadian SIH Conference: “Epidural Blood Patch: Technique, Mechanism, and Outcomes of Non-Targeted vs. Targeted Patching.”

Recorded video from the 2nd Canadian SIH Conference: “Fibrin Glue Patch: When to use, optimal technique, special tips and tricks, outcomes.”

Recorded video from the 2nd Canadian SIH Conference: “Embolization: Technique, pros and cons, to embolize or not to embolize, tips and tricks.”

References and Suggested Readings: