Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine

We explored the effect of fibrin glue injection at the site of dural punctu re on cerebrospinal fluid (CSF) leakage in a swine model. Pigs were subject ed to a lumbar dural CSF puncture in the sitting position with a 17-gauge T uohy needle. Fibrin glue 1.4 mL was injected through the same needle into t he epidural space. Evans blue dye was infused through the cisterna magna 15 min later, and the appearance of dyed CSF through the skin puncture and al ong the needle trajectory to the dura was inspected and categorized. In sev en of eight animals, the CSF leak was sealed with fibrin glue. Control anim als were injected with 1.4 mL saline. A sham operation group of animals und erwent cisternal dye infusion without a lumbar puncture. CSF pressure at th e cisterna magna was recorded throughout the procedure. No significant diff erences in the leakage indicators were found between the fibrin glue-inject ed and sham-operated group whereas both groups showed significant differenc es with respect to the control group. The fibrin glue seal was effective ag ainst CSF pressures of 24.5 [17-31] cm H2O. We conclude that percutaneously injected fibrin glue is effective in stopping CSF leaks after dural punctu re in this animal model. Implications: In this swine study, we repaired a c erebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue see ms promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.