Treating a Chronic CSF Leak with Stem Cells
CD is a 49 year old female who with a collagen synthesis problem that impacts her dura. This has caused multiple dural leaks through the years, a condition known as “Spontaneous Cerebrospinal Fluid Leak“. The dura is the covering of the spinal cord and holds the fluid around the spinal cord, nerve roots, and brain. When it’s torn, the Cerebrospinal Fluid (CSF) leaks out, causing the brain to loose its normal buoyancy in this fluid. This condition can be associated with severe and disabling headache while standing, dizziness, nausea, fatigue, a metallic taste in her mouth, ringing in the ears, etc. The patient was treated frequently first with epidural blood patches and then with CT guided Tisseal (fibrin glue) injections into her epidural space to try and patch the leaks. Since she had multiple areas that were leaking, this was a difficult treatment. In addition, since this fibrin product is derived from human donors, she also came down with Hepatitis from a bad lot. Despite these hardships from the procedure, this fibrin glue blood patching procedure would give her short-term relief lasting 2-3 weeks where she was quasi-functioning. While we’re experts in interventional spine procedures like epidural blood patches, we normally don’t treat these patients with chonic CSF leaks with stem cells. However this patient had unique needs and severe medical complications with traditional approaches to her dural leaks (the Hepatitis from the Tissel injection) as well as poor long-term results from these therapies (2-3 weeks of quasi-normal functioning after a CT-Guided blood patch with Tisseal). As a result of these issues plus the fact that she was very knowledgeable about her own condition, we agreed to use the Regenexx-SCP procedure with activation (to gel the sample and provide structure to the patch) as a fluoroscopically guided epidural CSF leak stem cell patch. As of 8/3 she was 4 weeks out from her Regenexx-SCP procedure and wrote this acessment:.
“Currently my headache is zero upon rising (my usual), and has not escalated beyond the moderate range, even after 10-12 hours upright. This is FABULOUS when compared to my baseline of 4-6 hrs upright daily, which are cumulative hrs, not all at once. So far this is substantially better than I expected. ”
Of note, she’s already gotten about 5 weeks total relief at the time of this writing, so she’s now doubled the duration of her usual epidural Tisseal patch. We will continue to follow the patient but are encouraged.