THE EFFECT OF FIBRIN GLUE PATCH IN AN IN-VITRO MODEL OF POSTDURAL PUNCTURE LEAKAGE

We studied the possibility of stopping a continuing transdural leakage with fibrin glue, a biologic adhesive, in an in vitro model. The mode l was made by sealing the bottom of a tube filled with saline to a hei ght of 50 cm with a human lyophilized dural specimen. Dural punctures were performed with a 17-gauge Tuohy needle. The needle was then withd rawn, and 0.8 mt of fibrin glue was injected through the same needle t o seal the defect. The column was refilled 3 min after sealing. The pr essure in the intrathecal chamber was measured during the procedure. M acroscopic and microscopic histological studies of the dura and the fi brin plug were performed. In the five cases studied, the leak was seal ed by the fibrin plug at closing pressures of 25-35 cm H2O, and no fur ther leakage was detected after refilling. The dural specimens showed a fibrin glue plug stuck at the edges of the hole. We conclude that fi brin glue stops leakage of fluid from dural holes created by a 17-gaug e Tuohy needle in an in vitro pressurized model. Implications: We expl ored the possibility of repairing a cerebrospinal fluid leak produced by an accidental dural puncture during epidural anesthesia by percutan eously injecting tissue adhesive in vitro. This technique seems promis ing for the prophylaxis and treatment of the headache associated with this leakage but requires further study in vivo.