Interesting article on alternative to EBP ... eman?

[LauraL840]

Interesting article 'Epidural dextran–40 and paramethasone injection for treatment of spontaneous intracranial hypotension'.

http://www.cja-jca.org/cgi/content/abstract/53/6/591

[eman]

Funky stuff,

is this new? I got an email back from a neurosurgeon that told me Fibrin glue works 70-80% of the time when EBP fails. I don't think that anyone actually uses fibrin glue in the manner of targeting multiple segments with one shot.

eman

[LauraL840]

My understanding (while VERY limited) is that less fibrin is used in comparison with blood. Fibrin essentially forms a plug where it's placed, but the blood forms a patch extending a couple inches in all directions from where it's placed. Also, I think that the blood patch is accomplishing TWO different types of treatment; it increases pressure on the spine which increases CSF pressure to relieve headache, AND it forms a patch to help seal/heal the leak. Whereas fibrin is used to seal. One of the studies I have shows successful use of a combination of fibrin and blood in a patch which helps the patch stay in place longer (which I think would work in my DH's case!). http://www.ajronline.org/cgi/content/full/175/2/443

Unfortunately for those of us in the US, MOST of the 'published' information on fibrin usage comes from Europe. It seems that either they are using it more, or just eager to publish.....

Another fibrin article that was informative.....
http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-199908000-00039.htm;jsessionid=G5XYwPpD2kvtml5nbGp6GqTF2JgTs Vzhxx7TSCGSbvnLNZCZVctm!3145886!-949856145!8091!-1

[eman]

According to this article, Dextran-40 is a dud, like saline:

http://bja.oxfordjournals.org/cgi/content/full/91/5/718


Epidural dextran
Despite the paucity of evidence to support epidural saline, some observers have considered the epidural administration of Dextran 40.117 Those studies that recommend Dextran 40, either as an infusion or as a bolus, conclude that the high molecular weight and viscosity of Dextran 40 slows its removal from the epidural space. The sustained tamponade around the dural perforation allows spontaneous closure. However, it is unlikely that Dextran 40 will act any differently to saline in the epidural space. Any pressure rise within the subarachnoid space would, like saline, be only transient. Histological inspection of the epidural space after administration of Dextran 40,74 does not demonstrate any inflammatory response that would promote the healing process. The evidence for the administration of epidural Dextran to treat post-dural puncture headache is not proven and the theoretical argument to justify its use is poor.

[eman]

Please post if you guys end up getting the fibrin glue injections.

eman