Background and Goal of Study: Spinal and intracranial haematomas are feared complications of central neuraxial anaesthesia. As these complications occur rarely, characteristics, symptoms, patterns of treatment and outcome have been unclear.
Materials and Methods: Medline, Embase and the Cochrane Library databases were searched for reports of spinal and intracranial haematomas and abscesses associated with CNB. Characteristics, risk factors, treatment and outcome were analysed.
Results and Discussion: A systematic literature search yielded 3013 articles, of which 375 articles were reviewed; 373 cases of spinal haematoma (SH) and 110 cases of intracranial haematoma (IH) were reported. SH occurred most frequently after epidural anaesthesia (59.4%) and developed predominately after catheter removal (37.0%). IH was principally seen after spinal anaesthesia (50.0%). Overall, neurological recovery after treatment was correlated with initial neurological deficit. In patients with SH, delayed treatment was associated with worse neurological outcomes (odds ratio [OR] 4.6, 95% CI 2.1 – 10.1; p = 0.001 and adjusted OR 2.4, 95% CI 1.1 – 5.4; p = 0.031). 
Conclusion(s): Patients can experience spinal or intracranial haematoma after CNB. Caution should be taken when interpreting the results of this review, since publication bias, selection bias and underreporting of complications may have influenced the results, however we believe that the information of this review is helpful in understanding rare severe complications of CNB. Based on the results we can conclude that in patients with decision for neurosurgical evacuation, intervention should be performed as soon as possible. In patients without neurological symptoms, conservative management may be attempted, pending continuous and careful patient monitoring. Conservative treatment might be feasible for more patients than was previously expected, however since these results are based on individual cases, care should be taken when drawing conclusions and neurosurgical decompression seems to be justified for these iatrogenic complications of CNB.

Systematic review of spinal and intracranial complications after central neuraxial blocks for perioperative and obstetric anaesthesia and analgesia. Part I: hematoma