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

Wong, Kevin; Monroe, Brian R.

doi:10.1111/papr.12541

Cited by 26 publications

(21 citation statements)

References 17 publications

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“…Although a blood patch could be one plausible option to prevent CSF leakage in individual cases, it is risky due to the difficulty of accurate positioning to the target area [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

2020

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Here we perform a retrospective analysis regarding an incidental dural tear (IDT) during biportal endoscopic spinal surgery (BESS). Purpose: This study investigates the causes of IDT specifically related to technical procedures of BESS with the aim of lowering its risk during training. Overview of Literature: The incidence of dural tear is reported 0.5%-18% in open spinal surgery and 1.7%-4.3% during endoscopic spinal surgery. Because conversion to open surgery for direct repair could become necessary during endoscopic spinal surgery, prevention of this complication is essential. Methods: We have retrospectively studied IDTs by four surgeons during 1 or 2 years after starting BESS for lumbar degenerative diseases and analyzed the locations, sizes, and specific endoscopic conditions specific to each. Results: Twenty-five cases (1.6%) of IDTs among 1,551 cases of BESS occurred; 13 cases (52%) of these were within the first 6 months. The locations were dorsal midline in 12 cases, ipsilateral side in 11 cases, and contralateral side in two cases. The tear sizes were <10 mm in 20 cases and ≥10 mm in five cases. IDT commonly occurred due to injury of central dural folding during flavectomy under turbid surgical fields due to small bleeds under water. Twenty cases with IDTs of <10 mm were treated well with the patch technique. Among five cases of ≥10 mm, three underwent open repair within a few days, and two of these which failed to conservative management required a delayed revision operation due to pseudomeningocele. No cases progressed to surgical site infection or infectious spondylitis. Conclusions: IDTs of <10 mm can be successfully treated with the patch technique. To prevent IDT during the early learning period, maintaining clear visibility by securing fluent saline outflow and meticulous hemostasis of small bleeding from exposed cancellous bone and epidural vessels is essential with caution not to injure the central dural folding during midline flavectomy.

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“…Although a blood patch could be one plausible option to prevent CSF leakage in individual cases, it is risky due to the difficulty of accurate positioning to the target area [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

2020

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“…The standard management strategy for SDH generally involves decompression surgery or conservative care with close observation depending on the age of the hematoma, degree of the midline shift, clot thickness, and neurological status [ 4 , 18 ]. However, a different treatment strategy is necessary for the sealing of CSF leaks in patients with SIH-induced SDH [ 19 , 20 , 21 , 22 ]. Therefore, for optimal treatment in some patients with SDH, recognition of the possibility of SIH as a cause of SDH is important [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

Kim

Lee

et al. 2021

Diagnostics

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The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.

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“…Complications such as acute and chronic low back pain, radiculopathy, infection, arachnoiditis, spinal subdural hematoma, spinal epiarachnoid hematoma, intrathecal hemorrhage are less frequent [52]. In the most severe cases, epidural injection of fibrin glue or surgical repair of the dura is used [53]. Greater occipital nerve blockage is a very effective method that is technically easy to perform, it is minimally invasive, and with a low rate of neurological complications [54].…”

Section: Therapymentioning

confidence: 99%

Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

et al. 2019

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Introduction. Post-dural puncture headache is classified as a secondary headache attributable to non-vascular intracranial disorders and belongs to the group of headaches caused by low cerebrospinal fluid pressure. Etiopathogenesis. The pathogenesis is not completely clear, but it is thought to be caused by the cerebrospinal fluid leak through the duct opening. Cerebrospinal fluid efflux leads to a decrease in intracranial pressure and stretching of the pain sensitive intracranial structures. A drop in intracranial pressure can cause compensatory cerebrovascular vasodilation, contributing to the onset of a headache. Diagnosis and Therapy. Post-dural puncture headache clinically presents as an orthostatic headache. In most cases, the diagnosis is made based on a typical clinical picture and it can be confirmed by magnetic resonance imaging and measurement of cerebrospinal fluid pressure. The condition is usually benign, most often with spontaneous recovery. The therapy involves conservative treatment, medications, as well as some invasive methods: epidural blood patches, blockage of the greater occipital nerve, and in most severe cases, epidural injection of fibrin sealant or surgical dural repair. Conclusion. Post-dural puncture headache is a common complaint in the clinical practice of neurologists and anesthesiologists. The prognosis is usually favourable, while the therapy may include conservative or invasive treatment procedures.

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

Cited by 26 publications

References 17 publications

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

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