Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant

Report of four cases

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  • 1 Maxine Dunitz Neurosurgical Institute and Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California
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✓ 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.

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Contributor Notes

Address reprint requests to: Wouter I. Schievink, M.D., The Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, California 90048. email: schievinkw@cshs.org.
  • 1.

    Dillon WP, & Fishman RA: Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. AJNR 19:10011002, 1998 Dillon WP, Fishman RA: Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. AJNR 19:1001–1002, 1998

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  • 2.

    Evans RW: New daily persistent headache. Curr Pain Headache Rep 7:303307, 2003 Evans RW: New daily persistent headache. Curr Pain Headache Rep 7:303–307, 2003

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  • 3.

    Patel MR, , Caruso PA, & Yousuf N, et al: CT-guided percutaneous fibrin glue therapy of cerebrospinal fluid leaks in the spine after surgery. AJR 175:443446, 2000 Patel MR, Caruso PA, Yousuf N, et al: CT-guided percutaneous fibrin glue therapy of cerebrospinal fluid leaks in the spine after surgery. AJR 175:443–446, 2000

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  • 4.

    Schievink WI: Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol 60:17131718, 2003 Schievink WI: Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol 60:1713–1718, 2003

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  • 5.

    Schievink WI: Spontaneous spinal cerebrospinal fluid leaks. Neurosurg Focus 9 (1): Article 8, 2000 Schievink WI: Spontaneous spinal cerebrospinal fluid leaks. Neurosurg Focus 9 (1): Article 8, 2000

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  • 6.

    Schrijver I, , Schievink WI, & Godfrey M, et al: Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy. J Neurosurg 96:483489, 2002 Schrijver I, Schievink WI, Godfrey M, et al: Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy. J Neurosurg 96:483–489, 2002

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