ANAPHYLACTIC REACTIONS TO FIBRIN SEALANT INJECTION FOR SPONTANEOUS SPINAL CSF LEAKS

Spontaneous intracranial hypotension due to a spontaneous spinal CSF leak is an important cause of new-onset headaches, particularly in young and middle-aged adults.¹ Treatment has traditionally involved epidural blood patching or surgical CSF leak repair if conservative treatment, e.g., bed rest, fails.¹ Recently, percutaneous placement of fibrin sealant has emerged as an alternate therapy.^1-3 The fibrin sealant is injected through a large-bore needle into the epidural space at the site of the CSF leak. Allergic reactions following topical placement of fibrin sealants are caused by the presence of aprotinin, a proteinase inhibitor derived from bovine lung, but they are extremely rare (0.005% of applications).^4-6 Fibrin sealants contain a small amount of aprotinin to prevent lysis of the clot. Allergic reactions following intravascular administration of aprotinin during cardiac surgery are more common, occurring in less than 0.1% of initial applications but in 3% upon re-exposure.⁶ In approving aprotinin, the Food and Drug Administration recommended against its …