Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant. Report of four cases.
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.
Schievink
Wouter I
WI
Maxine Dunitz Neurosurgical Institute and Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. schievinkw@cshs.org
Maya
M Marcel
MM
Moser
Franklin M
FM
D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006261:Headache / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D013353:Subdural Effusion / Q000150:complications* / Q000628:therapy*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives