CSF-Venous Fistulas Arising Intraosseously within Bone Remodeled by Meningeal Diverticula

Area of Science:

• Neurosurgery
• Radiology
• Vascular Neurology

Background:

• Cerebrospinal fluid-venous fistulas (CVFs) are a recognized cause of spinal cerebrospinal fluid (CSF) leaks, often linked to spontaneous intracranial hypotension.
• Typically, CVFs originate from nerve root sleeve diverticula with venous drainage into epidural or intraosseous veins.

Purpose of the Study:

• To describe a unique subset of CVFs with primary intraosseous drainage within vertebral elements.
• To illustrate the imaging findings, treatment approaches, and outcomes for patients with these intraosseous CVFs.

Main Methods:

• Multi-institutional case series review.
• Analysis of imaging findings, treatment strategies, and patient outcomes.
• Identification of nine cases exhibiting primary intraosseous venous drainage.

Main Results:

• Nine cases of CVFs with primary intraosseous drainage were identified.
• These unique CVFs can occur throughout the vertebrae.
• The intraosseous nature of the fistula influences treatment decisions.

Conclusions:

• Intraosseous cerebrospinal fluid-venous fistulas represent a distinct entity within spinal CSF leaks.
• Understanding the primary intraosseous drainage is crucial for effective management.
• This phenomenon may be associated with meningeal diverticula remodeling adjacent vertebral bone.