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Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
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CT-guided Fibrin Glue Occlusion of Cerebrospinal Fluid-Venous Fistulas

Mark D Mamlouk1, Peter Y Shen1, Mark F Sedrak1

  • 1From the Department of Radiology, The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, 700 Lawrence Expy, Santa Clara, CA 95051 (M.D.M., P.Y.S.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.D.M., W.P.D.); and Department of Neurosurgery, The Permanente Medical Group, Kaiser Permanente Medical Center, Redwood City, Redwood City, Calif (M.F.S.).

Radiology
|March 2, 2021
PubMed

Insights

CT-guided fibrin glue occlusion effectively treats cerebrospinal fluid-venous fistulas (CVFs), offering a successful alternative to surgery. This minimally invasive approach resolves CVFs and alleviates symptoms of spontaneous intracranial hypotension.

Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Neurology

Background:

  • Cerebrospinal fluid-venous fistulas (CVFs) are an uncommon cause of spontaneous intracranial hypotension.
  • Traditional open surgical ligation has limited success rates for CVFs.
  • Percutaneous treatments for CVFs have historically shown poor outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of CT-guided fibrin glue occlusion for treating CVFs.
  • To assess treatment outcomes and patient symptom resolution following fibrin glue embolization.

Main Methods:

  • Retrospective review of 13 patients with CVFs treated with CT-guided fibrin glue occlusion.
  • Post-treatment decubitus CT myelography (CTM) assessed CVF resolution.
  • Pre- and post-treatment brain MRI and clinical evaluations documented symptom changes.

Main Results:

  • Successful CVF resolution was confirmed in 10 out of 10 patients via CTM.
  • All 13 patients demonstrated improvement in spontaneous intracranial hypotension signs on MRI.
  • All patients achieved an asymptomatic status post-treatment.

Conclusions:

  • CT-guided fibrin glue occlusion is a highly effective treatment for cerebrospinal fluid-venous fistulas.
  • Directly administering fibrin glue into the CVF appears crucial for successful outcomes.
  • Further research is warranted to establish the long-term efficacy of this interventional technique.

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