Successful Treatment of Spontaneous Intracranial Hypotension by Plugging the Cerebrospinal Fluid Leak with Percutaneous Cyanoacrylate Injection: A Report of 2 Cases

Abstract

Spontaneous intracranial hypotension (SIH) is a well-known, but under- or misdiagnosed, condition caused by cerebrospinal fluid leak resulting from idiopathic dural breach. Blind lumbar epidural blood patch is an effective treatment in most cases, but occasionally, even targeted epidural blood patch fails to lead to improvement. In these cases, the cerebrospinal fluid leak is usually repaired surgically, especially for large dural breaches (>5 mm), once the site has been identified by imaging techniques (magnetic resonance myelography/computed tomography [CT] myelography/isotopic transit). We describe a less invasive percutaneous technique consisting of direct puncture into the epidural space with a 25-G needle to access the injection site under CT control. We report 2 cases with good technical and clinical outcome after 1 and 8 years of follow-up (clinical evaluation and brain imaging control by CT). The technique we describe here is of high interest in refractory SIH or for the serious form of the disease, before considering surgical repair. Further prospective studies are required to provide general guidelines in treatment options for patients with SIH.