A copy of the written consent is available for review by the Editor-in-Chief of this journal. Justin J. Elwood, Email: ude. Misha Dewan, Email: moc. Jolene M. Smith, Email: moc. Bahram Mokri, Email: ude. William D. Mauck, Email: ude. Jason S. Eldrige, Email: ude. National Center for Biotechnology Information , U. Published online Mar Elwood , Misha Dewan , Jolene M. Smith , Bahram Mokri , William D. Mauck , and Jason S. Misha Dewan S. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Jan 15; Accepted Mar 4. This article has been corrected. See Springerplus. This article has been cited by other articles in PMC. 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.
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.
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. Conclusions We did not achieve a similar frequency of headache resolution as reported in prior original studies. Background Headache associated with spontaneous intracranial hypotension SIH is often although not always orthostatic provoked or aggravated in upright position and decreased or relieved in recumbency.
Methods Following IRB approval from our institution, we enrolled 8 patients—5 females and 3 males—with refractory headaches related to SIH or dural puncture and treated them with epidural injections of blood with fibrin glue at the L1 spine level. Open in a separate window. Results Each of our 8 patients reported pain scores using the NRS system at three time points Table 1.
Case number Sex Diagnosis Number of fibrin glue-blood patch procedures Pre-procedure pain score a 1-Week post-procedure pain score a 3-Month post-procedure pain score a 1 F Orthostatic, exertional, and valsalva headache 2 6 9 9 2 F Intracranial hypotension headache 1 10 10 10 3 F Intracranial hypotension headache 1 9 6 6 4 M Spontaneous CSF leak with headache 2 9 9 9 5 M Intracranial hypotension headache 1 8 3 8 6 F Intracranial hypotension headache 1 9 9 3 7 M Intracranial hypotension headache 1 7 5 2 8 F Intracranial hypotension headache 1 3 3 0.
Discussion The purpose of our study was to evaluate the efficacy of epidural injection of combined fibrin glue and blood to treat medically refractory low CSF pressure, low volume headaches. Conclusions We noted some benefit for some patients from the injection of both fibrin glue and autologous blood into the epidural space. Competing interests The authors declare that they have no competing interests. Consent Written informed consent was obtained from the patients for publication of this report and any accompanying images.
Contributor Information Justin J. Early epidural blood patch in spontaneous intracranial hypotension. Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients. J Neurosurg. Treatment of spontaneous intracranial hypotension: evolution of the therapeutic and diagnostic modalities. Neurol Sci.
Epidural blood patch in the treatment of spontaneous low CSF pressure headache. Intracranial hypotension with spinal pathology. Spine J. Refractory headache: one term does not cover all—a statement of the European Headache Federation. J Headache Pain. Neurol Clin. Postoperative cerebrospinal fluid leaks of the lumbosacral spine: management with percutaneous fibrin glue.
This content does not have an English version. This content does not have an Arabic version. Overview Cerebrospinal fluid CSF surrounds your brain and spinal cord and provides a cushion to protect them from injury. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Spinal cerebrospinal fluid leak. Mayo Clinic; Sun-Edelstein C, et al. Spontaneous intracranial hypotension: Pathophysiology, clinical features and diagnosis.
Accessed July 20, Spontaneous intracranial hypotension: Treatment and prognosis. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. Jankovic J, et al. It may be used in isolation or in combination with whole blood. The findings and interpretation of spinal imaging is of critical importance in surgical planning and outcomes.
Surgical repairs are often less technically straightforward than might be anticipated, due to frequently noted abnormal dura and the variety of anatomic leak types and locations. The specific approach is tailored to the type and location of the leak and to the individual patient. Dural defect repaired Reproduced with permission from Wouter I.
When other measures have failed, some procedures have been used in carefully selected patients to reduce the severity of symptoms, such as epidural saline infusions via indwelling epidural catheter, or lumbar dural reduction surgery. Foundation founder Dr. Connie Deline and Dr. Wouter I. Schievink discuss treatment options for spinal CSF leak.
Conservative: Symptom Management A conservative approach to treating spinal CSF leak involves managing symptoms as they arise. For general symptoms:. For nausea:. For pain:.
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