자발성 두개내 저압증 환자에서 생체 접착제를 이용한 뇌척수액루의 치료: 수술수기

Abstract

Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is rare but important cause of postural headache. For most patients with intracranial hypotension, spinal epidural blood patching is an effective treatment. The author describe a 38-year-old female patient of lumbar CSF fistula treated with percutaneous placement of fibrin glue. This patient showed typical magnetic resonance imaging findings including diffuse dural enhancement and subdural fluid collections. The fistula site was clearly detected on the myelography computerized tomography. The patient got symptom-free initially with lumbar blood patch, but she was rehospitalized for recurrent headache and dizzy feeling. The patient became asymptomatic within days of the novel procedure with injecting of fibrin glue into the dural CSF leaking point. Transcutaneous patching of spinal CSF fistula with a biological glue is a safe, effective, and less invasive treatment for spontaneous intracracranial hypotension in patients in whom conservative and traditional methods has failed.