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Review
. 2025 Mar 25;29(1):70.
doi: 10.1007/s11916-025-01381-4.

Prophylactic Fibrin Glue Application for Immediate Management of Dural Puncture during Spinal Cord Stimulation Lead Placement: a Simple and Effective Technique

Roberto Gazzeri  1 , Marcelo Galarza  2 , Felice Occhigrossi  3 , Omar Viswanath  4   5 , Giustino Varrassi  6 , Matteo Luigi Giuseppe Leoni  7
Affiliations
Review

Prophylactic Fibrin Glue Application for Immediate Management of Dural Puncture during Spinal Cord Stimulation Lead Placement: a Simple and Effective Technique

Roberto Gazzeri et al. Curr Pain Headache Rep. .

Abstract

Background: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: CSF leakage; Dural leak; Dural puncture; Durotomy, repair technique; Spinal cord stimulation.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests. Institutional Review Board Statement: The study received approval from the institutional review board (IRB 339/2024/OSS), and informed consent was obtained from all participants.

References

    1. Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004;100(3 Suppl Spine):254–67. https://doi.org/10.3171/spi.2004.100.3.0254 - DOI - PubMed
    1. Kapural L, Yu C, Doust MW, et al. Novel 10-kHz High-frequency therapy (HF10 therapy) is superior to traditional Low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology. 2015;123(4):851–60. https://doi.org/10.1097/ALN.0000000000000774 - DOI - PubMed
    1. Joosten EA, Franken G. Spinal cord stimulation in chronic neuropathic pain: mechanisms of action, new locations, new paradigms. Pain. 2020;161(1):S104–13. https://doi.org/10.1097/j.pain.0000000000001854 - DOI - PubMed - PMC
    1. Gazzeri R, Castrucci T, Leoni MLG, Mercieri M, Occhigrossi F. Spinal cord stimulation for intractable chronic limb ischemia: A narrative review. J Cardiovasc Dev Dis. 2024;11(9):260. https://doi.org/10.3390/jcdd11090260 - DOI - PubMed - PMC
    1. Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: A review of the literature. Pain Med Malden Mass. 2016;17(2):325–36. https://doi.org/10.1093/pm/pnv025 - DOI

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