Cerebrospinal fluid (CSF) leak,
intracranial hypotension, and
postdural puncture headaches are common following dural
punctures. Management usually consists of
conservative treatments with medications (e.g.
caffeine, nonsteroidal anti-inflammatory drugs,
steroids,
opioids), increased fluid intake, and
bed rest. In more severe and persistent cases, epidural blood patches (EBPs) are indicated. When multiple EBPs fail,
epidural injection of
fibrin sealant has been successful in a few reported adult cases. The authors describe the first reported clinical experiences of epidural
fibrin patch in children for repair of CSF leak and resolution of
intracranial hypotension. This technique was used in three cases where serial EBPs failed to resolve symptoms related to
intracranial hypotension following dural
puncture. Following the procedure, each patient had resolution of their presenting clinical symptoms and radiographic abnormalities, and there were no noted complications. Epidural
fibrin sealant injection is a reasonable option for relieving
intracranial hypotension due to CSF leak following dural
puncture in children.