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Multiple Synchronous CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: A Multi-Institutional Case Series.
Ajay A Madhavan1, Timothy J Amrhein2, Michelle L Kodet3
1From the Department of Radiology (A.A.M., M.L.K., I.T.M.), Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota ajaymadhavan023@gmail.com.
AJNR. American Journal of Neuroradiology
|June 26, 2025
Summary
Multiple CSF-venous fistulas (CVF) are rare in spontaneous intracranial hypotension (SIH). This study presents the largest cohort to date of patients with three or more concurrent CVFs, detailing their characteristics and outcomes.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neurology
Background:
- Spontaneous intracranial hypotension (SIH) is often caused by cerebrospinal fluid (CSF)-venous fistulas (CVF).
- Increased recognition of CVFs is due to advancements in imaging and myelography techniques.
- While single or double CVFs are common, multiple (three or more) concurrent CVFs are exceptionally rare.
Purpose of the Study:
- To present the largest multi-institutional series of patients with three or more concurrently discovered CSF-venous fistulas.
- To describe the clinical features, imaging findings, treatment strategies, and outcomes in this rare patient cohort.
Main Methods:
- Multi-institutional case series.
- Review of clinical data, imaging findings (including myelography, cone beam CT myelogram, digital subtraction myelography), treatment approaches, and patient outcomes.
Main Results:
- The study identified sixteen patients with three or more concurrently discovered CSF-venous fistulas.
- Detailed descriptions of their clinical presentations, radiological findings, and therapeutic interventions are provided.
- Outcomes associated with various treatment strategies are analyzed.
Conclusions:
- This series represents the largest documented cohort of patients presenting with multiple (≥3) concurrent CSF-venous fistulas.
- Understanding the characteristics and management of these rare cases is crucial for improving patient outcomes in SIH.
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