Epidural Fibrin Glue Injection Stops Persistent Postdural Puncture Headache

RECENTLY we reported the successful treatment of persistent cerebrospinal fluid leak during long-term intrathecal catheterization with the epidural injection of fibrin glue (Tissucol, duo 500; Immuno AG, Vienna, Austria) in three patients with preterminal cancer who had severe pain.'In this case report, we describe the successful treatment of persistent postdural puncture headache in a woman after spinal anesthesia. Case ReportA 29-yr-old woman was scheduled for ligament repair of the right knee and removal of osteosynthesis material in the right tibia under spinal anesthesia.After three attempts, lumbar puncture with a 25gauge pencil-point needle was successful.Spinal anesthesia was instituted with 3 .5 ml hupivacaine (plain), 0.5%.Anesthesia and surgery were uncomplicated.Six hours after surgery, the patient experienced a neck ache radiating into the occipital region accompanied by nausea and vomiting.Sitting up aggravated the symptoms.Because of these problems, the patient was kept in the hospital for one night.She was sent home the next and advised to remain in bed, drink fluids, and take acetaminophen orally.Her headache did not subside, so it was decided on day 2 after surgery to administer an epidural injection of 10 ml autologous blood between spinal levels L3 and L4.During injection, the patient experienced severe back pain radiating to her left leg.After this therapy, the headache pain lessened.She tried to resume work 8 days after surgery.