title: Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report.
abstract: BACKGROUND
  Injection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid (CSF) leaks and subsequent intracranial hypotension has recently been described. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique.
  
  
  METHODS
  Eight patients with medically refractory headache resulting from intracranial hypotension caused by spinal CSF leaks received epidural injections of combined fibrin glue, autologous blood, and Isovue contrast at the L1-2 vertebral level using intermittent fluoroscopic guidance. Pre-procedure, 1-week post-procedure, and 3-month post-procedure headache pain scores were collected and used for comparison.
  
  
  RESULTS
  Three out of 8 patients reported relief at 1 week, although 1 of these 3 patients had returned to their baseline pain intensity at 3 months. Four patients reported no change at 1 week, though 2 of these patients had reduction of their chronic headache pain at 3 months. A single patient reported increased pain 1 week after the procedure, which persisted at 12 weeks. Overall, 4 out of the 8 patients had decreased pain scores at 3-month follow-up.
  
  
  CONCLUSIONS
  We did not achieve a similar frequency of headache resolution as reported in prior original studies. However, a subset of patients did appear to receive substantial benefit from the combined fibrin glue-blood patching procedure. This technique may prove to be useful in medically refractory cases, including those patients who continue to have symptoms despite the prior administration of conventional epidural blood patches.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Elwood
authors.affiliation: S.E. PA Pain Management, 721 Dresher Road, Suite 2500, Horsham, PA 19044 USA.
authors.forename: Misha
authors.initials: M
authors.lastname: Dewan
authors.affiliation: Pain Specialists of Iowa, 12499 University Ave, Suite 280, Clive, IA 50325 USA.
authors.forename: Jolene M
authors.initials: JM
authors.lastname: Smith
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
authors.forename: Bahram
authors.initials: B
authors.lastname: Mokri
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Mauck
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Eldrige
keywords: Blood patch; Fibrin glue; Orthostatic headache; SIH; Spontaneous intracranial hypotension