ANAPHYLACTIC REACTIONS TO FIBRIN SEALANT INJECTION FOR SPONTANEOUS SPINAL CSF LEAKS

Abstract

Spontaneous intracranial hypotension due to a spontaneous spinal CSF leak is an important cause of new-onset headaches, particularly in young and middle-aged adults.1 Treatment has traditionally involved epidural blood patching or surgical CSF leak repair if conservative treatment, e.g., bed rest, fails.1 Recently, percutaneous placement of fibrin sealant has emerged as an alternate therapy.1-3 The fibrin sealant is injected through a large-bore needle into the epidural space at the site of the CSF leak. Allergic reactions following topical placement of fibrin sealants are caused by the presence of aprotinin, a proteinase inhibitor derived from bovine lung, but they are extremely rare (0.005% of applications).4-6 Fibrin sealants contain a small amount of aprotinin to prevent lysis of the clot. Allergic reactions following intravascular administration of aprotinin during cardiac surgery are more common, occurring in less than 0.1% of initial applications but in 3% upon re-exposure.6 In approving aprotinin, the Food and Drug Administration recommended against its …