Anesth Pain Med.  2019 Jul;14(3):335-340. 10.17085/apm.2019.14.3.335.

Multiple epidural fibrin glue patches in a patient with spontaneous intracranial hypotension:A case report

• Lee YG
• Sa M
• Oh IS
• Lim JA
• Woo NS
• Kim JH

• KMID: 2454820
• DOI: http://doi.org/10.17085/apm.2019.14.3.335

Abstract

BACKGROUND
Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous leakage of cerebrospinal fluid, with postural headache as the primary symptom. Orthostatic headache caused by SIH is often not resolved by conservative management. CASE: We performed 15 epidural blood patch treatments in a 43-year-old female patient; however, they were only transiently effective. To improve the patient's SIH and orthostatic headache, epidural fibrin glue patch treatment was attempted. Fibrin glue is a substance that can act as a bio-friendly adhesive by facilitating the coagulation cascade. In our case, 3 epidural fibrin glue patch treatments were performed and the symptoms completely resolved.
CONCLUSIONS
The epidural fibrin glue patch may be beneficial for the treatment of refractory postural headaches caused by SIH.

Keyword

Epidural blood patch; Fibrin tissue adhesive; Headache; Intracranial hypotension

MeSH Terms

Adhesives
Adult
Blood Patch, Epidural
Cerebrospinal Fluid
Female
Fibrin Tissue Adhesive*
Fibrin*
Headache
Humans
Intracranial Hypotension
Adhesives
Fibrin
Fibrin Tissue Adhesive

Figure

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  Fig. 1 In the myelography performed after hospitalization, multiple cerebrospinal fluid leaks from C4 to T3 and left T5–6 along the nerve root sleeve were detected.

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  Fig. 2 In the myelography performed prior to the fibrin glue epidural patch treatment, multiple cerebrospinal fluid leaks from C4 to T3 along the nerve root sleeve were detected.

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  Fig. 3 An interlaminar approach was used between C7 and T1, and a transforaminal approach was used between T1 and T2, and T2 and T3; the location was confirmed by injection of a contrast medium.

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