Preventing CSF leakage syndrome by   Bioglue application during IDDS implantation procedure: A retrospective study.

Background and Aims
Post Dural Puncture Headache (PDPH) is the most frequent complication after IDDS implantation, 23% in a recent study.  Impact on patients' quality of life is significant, especially in oncology. Moreover, Cerebro Spinal Fluid (CSF) leakage can be responsible for serious complications. For neurosurgeons, Fibrin glue is an option to prevent and treat CSF leaks 
In this context, we developed an original technique to inject fibrin glue (BioGlue) into the puncture path during the catheter placement, in order to prevent CSF leakage. This study observed results on PDPH.

Methods
We retrospectively observed patient’s data after IDDS implantation to evaluate this technique in decreasing   incidence, length and severity of PDPH.
After approval by   local ethics committee, we conducted a comparative retrospective study of PDPHs between patients implanted before the implementation of the technique and those implanted with preventive glue injection. We assessed   incidence, duration and severity of PDPH following the Lybecker scale by double lecture of electronic records.

Results
199 patients were included, implanted between January 2017 and March 2019. 107 did not benefit from preventive Bioglue, 92 received Bioglue.
PDPH frequency decreased significantly from 32.7% to 10.87% (p=0.0002) .  The mean duration of PDPH decrease from 5.2 days to 2.8 days (p =0.0153) and severity also decreases since there are no severe PDPHs and the moderate rate goes from 34.2% to 20% and   Mild PDPH rate increase from 37% to 80%.  We observed no AEs.


Conclusion 
Preventive Bioglue significantly reduces of PDPH incidence and severity after IDDS implantation, No adverse effects were observed in these experience . this procedure seems a safe and easy procedure to prevent PDPH during IDDS implantation specially on frail cancer patients .

PREVENTING CSF LEAKAGE SYNDROME BY BIOGLUE APPLICATION DURING IDDS IMPLANTATION PROCEDURE: A RETROSPECTIVE STUDY.