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Treatment of Spontaneous Intracranial Hypotension with Percutaneous Placement of a Fibrin Sealant: Our Two Year Experience 2006

Interventional Spine

Franklin G Moser, M.D., ASSR Member
Wouter I Schievink, M.D., Non ASSR Member
Barry D Pressman, M.D., ASSR Member
Alexander S Jung, M.D., Non ASSR Member
Marcel M Maya, M.D., ASSR Member

Scientific Paper

Purpose

Previous reports have described the percutaneous image-guided placement of fibrin glue sealant in the treatment of postoperative cerebrospinal fluid (CSF) leaks (1). More recently, we have described its potential utility as a treatment of spontaneous intracranial hypotension (SIH) due to an underlying CSF leak (2). However, its efficacy and the durability of its effects in patients with SIH have not been well studied. Its role in management remains to be established. We report our continuing experience with this technique.

Methods & Materials

Over a two year period, transforaminal fibrin glue placement (Tisseel; Baxter Healthcare Corp, Deerfield, IL) via CT or fluoroscopic guidance was performed in 13 patients (range 19-52 years) who had failed conservative treatments and epidural blood patches. Symptomatic response was assessed at subsequent clinic or inpatient followup. The need for further treatments and operative repair was assessed by chart review. The follow-up period ranged from one week to two years.

Results

Five patients reported sustained symptomatic relief for several months. One patient reported sustained relief at seven days. Seven patients reported no or minimal relief, or persisting incapacitating symptoms.

Conclusion

Percutaneous fibrin glue placement appears to provide sustained symptomatic relief for some patients with spontaneous intracranial hypotension. This minimally invasive approach merits further consideration and evaluation. Based on our experience, this technique may prove to be the primary nonsurgical method of management in patients who have failed conservative treatments and epidural blood patches.

References

1. Patel MR et al. CT-guided percutaneous fibrin glue therapy of cerebrospinal fluid leaks in the spine after surgery. AJR 2000;175:443-446.
2. Schievink WI et al. Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant. J Neurosurg 2004;100:1098-1100.

The authors have no financial disclosures to report.