Elwood Justin J, Dewan Misha, Smith Jolene M, Mokri Bahram, Mauck William D, Eldrige Jason S
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
S.E. PA Pain Management, 721 Dresher Road, Suite 2500, Horsham, PA 19044 USA.
Springerplus. 2016 Mar 11;5(1):317. doi: 10.1186/s40064-016-1975-1. eCollection 2016.
Injection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid (CSF) leaks and subsequent intracranial hypotension has recently been described. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique.
Eight patients with medically refractory headache resulting from intracranial hypotension caused by spinal CSF leaks received epidural injections of combined fibrin glue, autologous blood, and Isovue contrast at the L1-2 vertebral level using intermittent fluoroscopic guidance. Pre-procedure, 1-week post-procedure, and 3-month post-procedure headache pain scores were collected and used for comparison.
Three out of 8 patients reported relief at 1 week, although 1 of these 3 patients had returned to their baseline pain intensity at 3 months. Four patients reported no change at 1 week, though 2 of these patients had reduction of their chronic headache pain at 3 months. A single patient reported increased pain 1 week after the procedure, which persisted at 12 weeks. Overall, 4 out of the 8 patients had decreased pain scores at 3-month follow-up.
We did not achieve a similar frequency of headache resolution as reported in prior original studies. However, a subset of patients did appear to receive substantial benefit from the combined fibrin glue-blood patching procedure. This technique may prove to be useful in medically refractory cases, including those patients who continue to have symptoms despite the prior administration of conventional epidural blood patches.
近期有研究报道，向硬膜外腔注射混合血液的纤维蛋白胶可可靠且有效地治疗因脊髓脑脊液漏及随后的颅内低压引起的药物难治性直立性头痛。本文所述研究采用类似技术来评估这种新技术的治疗可重复性。
8例因脊髓脑脊液漏导致颅内低压而出现药物难治性头痛的患者，在L1 - 2椎体水平使用间歇性荧光透视引导，接受硬膜外注射纤维蛋白胶、自体血和碘佛醇造影剂的联合治疗。收集术前、术后1周和术后3个月的头痛疼痛评分用于比较。
8例患者中有3例在1周时报告疼痛缓解，尽管这3例患者中有1例在3个月时恢复到基线疼痛强度。4例患者在1周时报告无变化，不过其中2例患者在3个月时慢性头痛疼痛减轻。1例患者在术后1周报告疼痛加重，且在12周时仍持续。总体而言，8例患者中有4例在3个月随访时疼痛评分降低。
我们未达到先前原始研究报道的类似头痛缓解频率。然而，一部分患者似乎确实从纤维蛋白胶 - 血液联合修补手术中获得了显著益处。这种技术可能在药物难治性病例中有用，包括那些尽管先前进行了传统硬膜外血贴但仍有症状的患者。
