Gazzeri Roberto, Galarza Marcelo, Occhigrossi Felice, Viswanath Omar, Varrassi Giustino, Leoni Matteo Luigi Giuseppe
Interventional and Surgical Pain Management Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain.
Curr Pain Headache Rep. 2025 Mar 25;29(1):70. doi: 10.1007/s11916-025-01381-4.
Accidental dural puncture during epidural lead insertion for Spinal Cord Stimulation (SCS) is a recognized surgical complication that may lead to cerebrospinal fluid (CSF) leakage and subsequent postdural puncture headache (PDPH). The optimal technical approach to prevent CSF leakage remains controversial. This study aimed to evaluate a simple and efficient intraoperative technique for managing accidental dural puncture during SCS lead placement.
A retrospective review was conducted of the medical records and imaging studies of all patients who underwent SCS procedures between January 2020 and April 2024. Signs or symptoms associated with dural puncture were recorded, including subcutaneous fluid collections, pseudomeningocele formation, PDPH, wound infection, and meningitis.
Among 107 patients who underwent SCS implantation, involving a total of 194 lead insertions, 4 cases (3.7%) of intraoperative CSF leakage due to iatrogenic dural puncture were identified. Each case was managed by injecting fibrin glue through the introducer needle into the epidural space, directly over the dural lesion.
Prophylactic application of fibrin glue following dural puncture appears to be highly effective in sealing the damage and preventing CSF leakage. This technique offers a valuable intraoperative solution for surgeons to immediately address dural injuries during SCS lead placement, potentially minimizing postoperative complications and improving patient outcomes.
脊髓刺激（SCS）硬膜外电极置入过程中意外硬膜穿刺是一种公认的手术并发症，可能导致脑脊液（CSF）漏出及随后的硬膜穿刺后头痛（PDPH）。预防脑脊液漏出的最佳技术方法仍存在争议。本研究旨在评估一种简单有效的术中技术，用于处理SCS电极置入过程中的意外硬膜穿刺。
对2020年1月至2024年4月期间接受SCS手术的所有患者的病历和影像学研究进行回顾性分析。记录与硬膜穿刺相关的体征或症状，包括皮下积液、假性脑脊膜膨出形成、PDPH、伤口感染和脑膜炎。
在107例行SCS植入术的患者中，共进行了194次电极置入，发现4例（3.7%）因医源性硬膜穿刺导致术中脑脊液漏出。每例均通过将纤维蛋白胶经引导针注入硬膜外间隙，直接注入硬膜损伤处进行处理。
硬膜穿刺后预防性应用纤维蛋白胶似乎在封闭损伤和预防脑脊液漏出方面非常有效。该技术为外科医生在SCS电极置入过程中立即处理硬膜损伤提供了一种有价值的术中解决方案，可能会减少术后并发症并改善患者预后。
