Transvenous Embolization for Cerebrospinal Fluid-Venous Fistula. A Case Series from a Single Community-Academic Center

Abstract

Transvenous embolization is a new treatment for spinal cerebrospinal fluid (CSF)-venous fistula, with only 1 reported large case series from the center that invented this technique. We report the clinical and radiographic data of 5 consecutive patients who were diagnosed with CSF-venous fistula at a single community-academic medical center and were treated with transvenous embolization. All patients provided consent for this report. Institutional review board approval was not required because of the retrospective nature of this study describing standards of care. Five patients, 3 men and 2 women, with a median age of 57 years, were diagnosed between March and December 2021with spontaneous intracranial hypotension (SIH) as a result of CSF-venous fistula. Two patients were originally referred for middle meningeal artery embolization for chronic subdural hematoma. All fistulae were in the thoracic spine at a single level in 3 patients, 2 levels in 1 patient, and multiple levels in 1 patient. Transvenous embolization was technically successful in all cases, with no significant complications. Four patients (80%) had complete or near-complete resolution of clinical symptoms and returned to baseline function and employment status. One patient (20%) has had a remitting relapsing course. Posttreatment brain magnetic resonance imaging showed resolution of spontaneous intracranial hypotension findings in 4 patients (80%) and minimal changes in 1 patient (20%), who had significant clinical improvement. Transvenous embolization for the treatment of CSF-venous fistula is feasible and seems effective in the short-term. The results reported by the previous case series can be reproduced in other centers with available expertise and adherence to published diagnostic and treatment protocols.