Seven months delay for epidural blood patch in post-dural puncture headache

Sir: The editorial [1] and article [2] published in your journal are very instructive and give a good overview of the value of an epidural blood patch. There is another possibility for the treatment of PDPH if the epidural blood patch fails. We have shown [3], that patients with persistent CSF leakage after insertion of an intrathecal catheter, can be successfully treated with an epidural injection of fibrin glue (Tissucol, duo 500, Immuno AG, Vienna, Austria). Epidural fibrin glue was also successfully used to stop PDPH 5 weeks after a single shot spinal anaesthetic [4]. Fibrin glue is a preparation of pooled human plasma obtained by plasmapheresis. A fibrin clot is formed by mixing two primary solutions. The fibrin glue was given by lumbar injection one interspace cephalad of the original puncture level to each patient, and the CSF leakage stopped the same day. B. M. GERRITSE M. J. M. GIELEN Institute for Anesthesiology, University Hospital Nymegen, Geert Grooteplein 10, 6500 GM Nymegen, The Netherlands