title: Novel hydrogel application in minimally invasive surgical approaches to spontaneous intracranial hypotension. Report of 2 cases.
abstract: The authors report 2 cases of orthostatic headaches associated with spontaneous intracranial hypotension (SIH) secondary to CSF leaks that were successfully treated with an alternative dural repair technique in which a tubular retractor system and a hydrogel dural sealant were used. The 2 patients, a 63-year-old man and a 45-year-old woman, presented with orthostatic headache associated with SIH secondary to suspected lumbar and lower cervical CSF leaks, respectively, as indicated by bony defects or epidural fluid collection. Epidural blood patch repair failed in both cases, but both were successfully treated with the minimally invasive application of a hydrogel dural sealant as a novel adjunct to traditional dural repair techniques. Both patients tolerated the procedure well. Moreover, SIH symptoms and MRI signs were completely resolved at 1-month follow-up in both patients. The minimally invasive dural repair procedure with hydrogel dural sealant described here offers a viable alternative in patients in whom epidural blood patches have failed, with obscure recalcitrant CSF leaks at the cervical as well as lumbar spinal level. The authors demonstrate that the adjuvant use of sealant is a safe and efficient repair method regardless of dural defect location.
authors.affiliation: Weill Cornell Brain Tumor and Stem Cell Laboratory.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Chai
authors.forename: Matei A
authors.initials: MA
authors.lastname: Banu
authors.forename: William
authors.initials: W
authors.lastname: Cobb
authors.forename: Neel
authors.initials: N
authors.lastname: Mehta
authors.forename: Linda
authors.initials: L
authors.lastname: Heier
authors.forename: John A
authors.initials: JA
authors.lastname: Boockvar
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000150:complications / Q000601:surgery*; D005260:Female; D006261:Headache / Q000209:etiology / Q000601:surgery; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000008:administration & dosage*; D019585:Intracranial Hypotension / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures / Q000379:methods
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate
keywords: DuraSeal; EBP = epidural blood patch; SIH = spontaneous intracranial hypotension; cerebrospinal fluid leak repair; dural repair; hydrogel; orthostatic headache; spontaneous intracranial hypotension; surgical technique