Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant

Abstract

Spontaneous intracranial hypotension due to a cerebrospinal fluid (CSF) leak in the spine is an important cause of new, daily persistent headaches. Most patients respond well to conservative treatments including epidural blood patching. Limited options for effective treatment are available for patients in whom these treatments fail. The authors treated four patients (mean age 38 years; range 26-43 years) with percutaneous placement of a fibrin sealant. All these patients presented with intractable positional headaches. The CSF leak was located in the lower cervical spine in three patients and in the lower thoracic spine in one patient. Four to 20 milliliters of fibrin sealant was injected at the site of the CSF leak. Two of the four patients became asymptomatic within days of the procedure and thus avoided surgery. There were no complications of this procedure. Percutaneous placement of a fibrin sealant is a safe, minimally invasive treatment for spontaneous spinal CSF leaks and should be considered in patients in whom conservative treatment has failed.

Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective

“…32,33 Persistent cases may require neurosurgical consultation for fibrin sealants or surgical repair. 34,35 The natural history and long-term outcomes of SIH are not well known as large prospective studies are lacking, likely due to the rarity of the condition and frequent misdiagnosis. MRI findings may correlate to headache resolution, which was seen in 25 of 26 patients (97%) with abnormal MRIs compared to only 1 of 7 patients (14%) with a normal MRI.…”

“…Bedrest to avoid upright position 5,19 Oral or intravenous rehydration 5,19 Oral or intravenous caffeine 5,19,26,27 Oral glucocorticoids 28 Invasive therapies (neurosurgical or anesthesia consultation) Epidural glucocorticoids 29 Intrathecal saline infusion 30 Epidural blood patch 32,33 Epidural fibrin sealant 34 Surgical repair 35 CSF 5 cerebrospinal fluid; ED 5 emergency department.…”

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

“…9 Prior authors have reported symptomatic improvement rates ranging from 50% to 100% with site-directed epidural blood/fibrin patch procedures by using CT or fluoroscopic guidance. [10][11][12][13][14][15] These treatment options, however, often require epidural punctures in the upper thoracic and cervical spine. Epidural puncture in these regions is technically more challenging due the anatomy and the epidural space becoming smaller as you ascend from the lumbar to the cervical region.…”

Targeted epidural catheter injection of polyethylene glycol hydrogel for repair of a spontaneous dural tear: a novel case report

“…This volume was also similar to that which had previously been reported as successful in stopping SIH via a percutaneous approach. 6,11 Also, imaging studies with this volume showed only mild displacement of the dural sac, without myelopathy.…”