Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report

Abstract

BackgroundInjection 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.MethodsEight 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.ResultsThree 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.ConclusionsWe 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.

An Unusual Cause of Chronic Headache in an Adolescent Boy: A Case Report

“…2,3,8,17 Autologous epidural blood patch offers immediate effect by a tamponade effect produced by the epidural injection of autologous blood that diverts CSF in to the intracranial compartment and delayed effect results from the sealing of CSF leak site. 18 Fibrin glue injection has been not only tried in patients where an epidural blood patch is not feasible but also in patients with headache refractory to epidural blood patch. 18 Combination of epidural blood patch and fibrin glue injections has also been tried in few cases with refractory headache.…”

“…18 Fibrin glue injection has been not only tried in patients where an epidural blood patch is not feasible but also in patients with headache refractory to epidural blood patch. 18 Combination of epidural blood patch and fibrin glue injections has also been tried in few cases with refractory headache. 18 Recurrence of CSF leaks has been reported in 10% of patients.…”

“…18 Combination of epidural blood patch and fibrin glue injections has also been tried in few cases with refractory headache. 18 Recurrence of CSF leaks has been reported in 10% of patients. 1 Patients with abnormal initial brain MRI have good outcome, while a normal initial MRI is a predictor of poor outcome.…”

Successful Treatment of Postdural Puncture Headache Using Epidural Fibrin Glue Patch after Persistent Failure of Epidural Blood Patches

“…Several case reports, small series, and cohort studies have reported the efficacy of epidural fibrin glue patching with and/or without blood for the treatment of spontaneous intracranial hypotension . Recently, a small prospective cohort study of 8 patients also proposed the efficacy of epidural blood patch with fibrin glue additive in patients with refractory headache related to spontaneous intracranial hypotension or dural puncture …”

“…Various risks to the use of fibrin glue have been described in the literature including the risk of infectious transmission, anaphylaxis, intravascular thrombosis, and nerve compression . Injecting fibrin glue through the epidural needle can pose significant challenges due to the high viscosity and rapid polymerization of fibrin sealant . We avoided these problems by flushing the needle with a small amount of saline prior to injecting the thrombin solution.…”