title: Alternative treatment of intracranial hypotension presenting as postdural puncture headaches using epidural fibrin glue patches: two case reports.
abstract: BACKGROUND
  Intracranial hypotension is a neurologic syndrome characterized by orthostatic headaches and, radiographically, by dural thickening and enhancement as well as subdural collections. Several of etiologies exist, including surgical dural violations, lumbar puncture, or spontaneous cerebrospinal fluid leak. Current management includes conservative management consisting of bed rest, caffeine, and hydration. When conservative management fails, open surgical or percutaneous options are considered. Currently, the gold standard in percutaneous management of intracranial hypotension involves the epidural injection of autologous blood. Recently, some therapies for intracranial hypotension have employed the use of epidural fibrin glue.
  
  
  METHODS
  Two cases of patients with persistent postdural puncture headaches are presented. Epidural fibrin glue injection alleviated the orthostatic headaches of two patients with intracranial hypotension.
  
  
  CONCLUSIONS
  Although consideration must be afforded for the potential risks of viral transmission and aseptic meningitis, the utilization of epidural fibrin glue injection as an alternative or adjunct to the epidural blood patch in the treatment of intracranial hypotension should be further investigated.
authors.affiliation: 1Department of Neurosurgery, Harvey Cushing Institute of Neurosciences, Hofstra University School of Medicine and North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Mammis
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Mogilner
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D051299:Post-Dural Puncture Headache / Q000150:complications / Q000628:therapy*
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics
keywords: Epidural; fibrin glue; intracranial hypotension