Percutaneous Injection Of Fibrin Glue Research Articles

Urinary fistulas after partial nephrectomy in renal cell carcinoma

Urinary fistulas after partial nephrectomy are rare complications of this operation. There are various reasons for their development, prevention and treatment. This review analyzes the results of the cases' prevalence of urine leakage after partial nephrectomy with various approaches, occurrence's predictors of urinary fistulas, possible ways of their intraoperative prevention and treatment methods. The obtained data show that the size of tumors, their endophytic nature and proximity to the kidney pelvicalyceal system, as well as suturing of its defect, can be predictors of the development of urinary fistulas (UFs). Some authors point to the influence of long ischemia time and high blood loss on the occurrence of UFs. The main method of treating UFs is ureteral stenting or percutaneous drainage of the kidney pelvicalyceal system. For long-term persistent UFs, the method of choice can be simultaneous introduction of 2 stents, retrograde or percutaneous injection of fibrin glue, percutaneous cryoablation of the UFs.

CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

Objective To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst. Methods Clinical data of 20 cases with“double-needle”injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed.All patients had varying degrees of sacral nerve root compression symptoms.The treatment for sacral cyst was carried out after clear diagnosis was made.On the basis of CT-guided percutaneous injection of fibrin glue,the improved CT-guided percutaneous injection of fibrin glue by“doubleneedle”technique was used to treat these patients.The average dose of fibrin glue was (5.9±2.4) ml.The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months.The assessment criteria were as follows: excellent,complete resolution of signs and symptoms,with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up,good,symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region,which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up),fair,no improvement in clinical symptoms,but a decrease in cyst size on the imaging study,poor,no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy,with most experiencing complete or marked resolution of clinical symptoms.Nine patients reported excellent recovery,8 reported good recovery,2 reported fair recovery,and 1 reported poor recovery.The overall percentage of positive outcomes (excellent and good recovery) was 85%.No serious postoperative complications were discovered. Conclusions CT guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst is an ideal method.“Double needle”technique is simple,safe and reliable. Key words: Sacral cyst; Punctures; Fibrin tissue adhesive; Radiology,interventional;

CT-Guided Percutaneous Injection of Fibrin Glue for the Therapy of Symptomatic Arachnoid Cysts

Although often asymptomatic, enlarging sacral arachnoid cysts can also cause significant discomfort. These symptomatic sacral arachnoid cysts require specific treatments to facilitate local decompression. The main drawback of the surgical managements is the high risk of recurrence and complications. To decrease risks, we had been attempting to seek a simple and safe method to manage the symptomatic sacral arachnoid cysts. CT-guided percutaneous fibrin glue therapy is a new nonsurgical alternative. To evaluate the efficacy of the novel nonsurgical approach, we conducted this retrospective study of 38 patients. Thirty-eight patients with symptomatic sacral arachnoid cysts underwent fibrin glue therapy in our hospital between June 2006 and May 2009. The clinical results of improvement in pain and neurologic function were evaluated after an average of 25 months of follow-up, and changes on the imaging findings were evaluated. Preoperative and postoperative pain severity was assessed according to a 10-cm VAS. Moreover, we also analyzed the postoperative complications. Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Twenty-one patients (55.3%) reported excellent recovery, 12 (31.5%) reported good recovery, 4 (10.5%) reported fair recovery, and 1 (2.6%) reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 86.8%. No serious postoperative complications were discovered. CT-guided percutaneous injection of fibrin glue therapy is simple, safe, and effective for the management of symptomatic sacral arachnoid cysts.

Spontaneous intracranial hypotension

Since the introduction of magnetic resonance imaging (MRI), spontaneous intracranial hypotension has been diagnosed much more frequently. The aim of this review is to discuss the symptoms and signs of the condition, in particular the characteristics of the associated headache, with sudden onset after sitting or standing, so that it can be included under the rubric of 'thunderclap headache'. This type of headache, like post lumbar puncture headaches, may be caused by cerebral vasodilatation and exacerbated by lowered pressure of the cerebrospinal fluid (CSF). Other symptoms include neck stiffness, nausea, vomiting, vertigo, tinnitus, deafness, and cognitive abnormalities. The clinical picture can sometimes mimic frontotemporal dementia, and the behaviour of some patients can sometimes be described as hypoactive-hypoalert, with somnolence, impaired attention, and stereotyped motor activity. Sagging of the brain, caused by leakeage of the CSF, can cause lesions in the brainstem with stupor, gaze palsies, and cranial nerve palsies. The condition can be a risk factor for cerebral venous thrombosis because of slowing of the blood flow and distortion of the blood vessels. The clinical picture may well suggest the diagnosis, but the headache may possibly indicate a subarachnoid haemorrhage. However, MRI will help to confirm the diagnosis and to localize the site of the CSF leak. MRI myelograms are of particular value, but if they are equivocal a computed tomography myelogram should be performed. The leakage of CSF is due to a tear in the dura, most frequently where the spinal roots leave the subarachnoid space. If this does not heal with bedrest, an epidural blood patch or a percutaneous injection of fibrin glue may be needed. More information is required on long-term follow-up.

011 Percutaneous fibrin glue injection for treatment of spontaneous spinal CSF leak

Background/Purpose: To assess the efficacy of CT guided percutaneous injection of fibrin glue for the treatment of spontaneous spinal CSF leak. Materials/Methods: 45 patients (34 women, 11 men) aged 19–70...

Spontaneous Spinal Cerebrospinal Fluid Leaks

Spontaneous intracranial hypotension is an uncommon but not rare cause of new onset daily persistent headaches. A delay in diagnosis is the norm. Women are affected more commonly than men and most are in the fifth or sixth decade of life. The underlying cause is a spontaneous spinal cerebrospinal fluid (CSF) leak. Typically the headache is orthostatic in nature but other headache patterns occur as well. Associated symptoms are common and include neck pain, a change in hearing, diplopia, facial numbness, cognitive abnormalities and even coma. Typical imaging findings consist of subdural fluid collections, pachymeningeal enhancement, pituitary hyperaemia and brain sagging, but magnetic resonance imaging may be normal. Myelography is the study of choice to identify the CSF leak but is not always necessary to make the diagnosis. Treatment consists of bedrest, abdominal binder, epidural blood patching, percutaneous fibrin glue injection or surgical CSF leak repair. Outcomes have been poorly studied.

Case Report: Percutaneous Fibrin Glue Injection for Urine Leakage in Laparoscopic Partial Nephrectomy

As laparoscopic techniques have advanced in the recent decade, laparoscopic partial nephrectomy (LPN) has been performed in patients with renal-cell carcinoma (RCC). Until recently, however, it has been a challenging procedure to perform because of its technical difficulty. We treated a 71-year-old man with a single kidney and RCC who subsequently underwent LPN. Urine leakage was detected postoperatively and continued for 30 days. It was managed with a percutaneous fibrin glue injection. Our report shows the therapeutic feasibility of fibrin glue for urine leakage, a complication of LPN.

Percutaneous fibrin glue therapy for meningeal cysts of the sacral spine with or without aspiration of the cerebrospinal fluid

The authors assessed the efficacy of computed tomography (CT)-guided percutaneous injection of fibrin glue to treat meningeal cysts of the sacral spine in patients with back pain, and evaluated the necessity for cerebrospinal fluid (CSF) aspiration before glue injection. Of the 31 patients in this study, 15 underwent injection of fibrin glue under CT guidance after aspiration of more than 15 ml of CSF (Group A), and 16 patients were treated with the glue but without CSF aspiration (Group B). Clinical results were evaluated after an average of 23 months of follow-up, and changes on the imaging studies were also evaluated. The clinical outcome and postoperative complications were analyzed. All 31 patients experienced resolution or marked improvement of symptoms for as long as 28 months after fibrin glue therapy. No patient experienced recurrence of symptoms during the follow-up interval. The postoperative pain relief was statistically significant (p < 0.001) according to evaluations in which a 100-mm visual analog pain scale was used. There were no statistical differences between the two groups (p > 0.05). Percutaneous CT-guided fibrin glue therapy for sacral arachnoid cysts may be a definitive therapy. It is unnecessary to aspirate the CSF before injection of the fibrin glue.

Cauda Equina Syndrome Resulting From Treatment of Dural Ectasia With Fibrin Glue Injection

The use of fibrin glue injection to treat symptomatic dural ectasia is controversial. A case of cauda equina syndrome following percutaneous fibrin glue injection is presented, followed by a review of dural ectasia and its possible treatments.

Percutaneous injection of fibrin glue for persistent nephrocutaneous fistula after partial nephrectomy

We report a case of persistent urinary leak of nearly 4 months’ duration after open surgical partial nephrectomy. The urinary leak was refractory to ureteral stenting, urethral catheter placement, and ureteroscopic fulguration. Fibrin glue was injected percutaneously under fluoroscopic guidance into the nephrocutaneous fistula tract, which resulted in its prompt and complete resolution.

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 puncture on cerebrospinal fluid (CSF) leakage in a swine model. Pigs were subjected to a lumbar dural CSF puncture in the sitting position with a 17-gauge Tuohy needle. Fibrin glue 1.4 mL was injected through the same needle into the 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 along the needle trajectory to the dura was inspected and categorized. In seven of eight animals, the CSF leak was sealed with fibrin glue. Control animals were injected with 1.4 mL saline. A sham operation group of animals underwent cisternal dye infusion without a lumbar puncture. CSF pressure at the cisterna magna was recorded throughout the procedure. No significant differences in the leakage indicators were found between the fibrin glue-injected and sham-operated group, whereas both groups showed significant differences with respect to the control group. The fibrin glue seal was effective against CSF pressures of 24.5 [17-31] cm H(2)O. We conclude that percutaneously injected fibrin glue is effective in stopping CSF leaks after dural puncture in this animal model. In this swine study, we repaired a cerebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue seems promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.

Fibrin Glue for Postoperative Persistent Cutaneous Fistula

In 14 patients with persistent external fistulas after an operation on the digestive system, percutaneous injection of fibrin glue was attempted for the purpose of immediate closing of the fistula on condition of a daily fistula output of less than lOOg. The overall efficacy rate was 57% (8/14 cases). Percutaneous fibrin glue injection to the fistula was successful in cases in which the discharge contained no intestinal fluid, but unsuccessful in cases in which the discharge contained intestinal fluid.