Household Cyanoacrylate is an Efficient and Safe Adhesive for Urgent Repair of Cerebrospinal Leaks

Background:Both transcranial and spinal cerebrospinal fluid (CSF) leaks are serious and potentially fatal conditions. Reparative surgery fails in 6% to 25% of cases. The so-called “super glue” cyanoacrylate is an acrylic resin that rapidly polymerizes in the presence of water, specifically hydroxide ions. The reaction proceeds rapidly and a strong bond is formed within seconds. Cyanoacrylate glues have been reported for their possible usefulness in the treatment of CSF leaks. Methods:In this report, the records of 1 female and 2 male patients aged between 43 and 68 years with low-pressure CSF leaks were retrospectively reviewed. The causes of fistulas were head trauma in 1 case and iatrogenicity during surgery for lumbar disc herniation in 2 cases. Results:In the 2 patients who underwent spinal surgery, primary repair was unsuccessful. The leaks were therefore sealed with cyanoacrylate glue packed between a cellulose-based hemostat and a fat plug. In the head injury case, the leak was treated with a periosteal graft attached to the injured dura with sutures. A cellulose-based hemostat followed by cynoacrylate glue was then applied. The patients have been followed up for between 3 and 6 years with no CSF leakage, infection, or neurological problems. Conclusion:Cyanoacrylate adhesive seems to be an efficient and safe alternative for the prevention of low-pressure CSF leaks.