R. Garcia-aguado et al., Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine, ANESTH ANAL, 90(4), 2000, pp. 894-898
Citations number
22
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
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.