A postdural puncture headache (PDPH) is a
well-described complication after implantation
of an intrathecal drug delivery system (IDDS).
Treatment is typically with supportive management
with the occasional need for an epidural
blood patch. We describe a case of a patient with
refractory muscle spasticity secondary to cerebral
palsy that required a baclofen IDDS implantation
and subsequently developed a PDPH. After failing
conservative therapy as well as an epidural
blood patch, the decision was made to attempt
an epidural fibrin patch, which transiently improved
her headache. Upon return of the patient’s
symptoms, computed tomography myelogram
demonstrated an extensive cerebrospinal fluid
leak with ventral spread into the retroperitoneal
space. Using a novel technique, a second epidural
fibrin glue patch was administered just adjacent to
the IDDS catheter insertion point, which was then
successful in resolving her symptoms.
Key words: Intrathecal drug delivery system,
postdural puncture headache, dural tear, cerebrospinal
fluid (CSF) leak, fibrin glue, epidural
blood patch
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