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A Novel Endovascular Therapy for CSF Hypotension Secondary to CSF-Venous Fistulas
W Brinjikji1,2, L E Savastano3,2, J L D Atkinson2
1Department of Interventional Neuroradiology (W.B., L.E.S.), Mayo Clinic, Rochester, Minnesota Brinjikji.waleed@mayo.edu.
Insights
Transvenous embolization of paraspinal veins effectively treats cerebrospinal fluid-venous fistulas causing spontaneous intracranial hypotension. This minimally invasive procedure offers significant headache relief and radiological improvement with no permanent complications.
Area of Science:
- Neurology
- Interventional Radiology
- Neurosurgery
Background:
- Spontaneous intracranial hypotension (SIH) is a debilitating condition often caused by cerebrospinal fluid (CSF)-venous fistulas.
- Traditional treatments for SIH can be invasive and may not always be effective.
- Identifying and treating the specific venous drainage of CSF fistulas is crucial for successful management.
Purpose of the Study:
- To report the first-ever cases of transvenous embolization of paraspinal veins for treating CSF-venous fistulas in patients with SIH.
- To evaluate the clinical and radiological outcomes of this novel treatment approach.
- To assess the safety and feasibility of the embolization procedure.
Main Methods:
- A consecutive case series of patients with SIH due to CSF-venous fistulas.
- Spinal venography via azygous vein catheterization.
- Selective catheterization and embolization of the draining paraspinal vein using Onyx.
- Clinical assessment of headache and radiological evaluation of pachymeningeal enhancement and brain sag.
Main Results:
- Successful transvenous embolization of the paraspinal vein was achieved in all patients.
- Significant headache improvement was observed, with 4 patients experiencing complete resolution and 1 patient a 50% reduction.
- Radiological findings showed resolution or improvement in pachymeningeal enhancement and brain sag in 4 patients.
- No permanent neurological complications were reported, and all patients were discharged on the procedure day.
Conclusions:
- Transvenous embolization of the paraspinal vein is a safe and effective treatment for CSF-venous fistulas causing SIH.
- This technique provides rapid symptom relief and radiological improvement.
- It represents a promising minimally invasive option for managing complex SIH cases.
Abstract:
We report a consecutive case series of patients who underwent transvenous embolization of the paraspinal vein, which was draining the CSF-venous fistula, for treatment of spontaneous intracranial hypotension. These are the first-ever reported cases of this treatment for CSF-venous fistulas. All patients underwent spinal venography following catheterization of the azygous vein and then selective catheterization of the paraspinal vein followed by embolization of the vein with Onyx. All patients had improvement of clinical and radiologic findings with 4 patients having complete resolution of headaches and 1 patient having 50% reduction in headache symptoms. Pachymeningeal enhancement resolved in 4 patients and improved but did not resolve in 1 patient. Brain sag resolved in 4 patients and improved but did not resolve in 1 patient. There were no cases of permanent neurologic complications. All patients were discharged home on the day of the procedure.
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