Multiple Synchronous CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: A Multi-Institutional Case Series

CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension. Due to the more routine use of decubitus myelography and advancements in various imaging techniques, recognition of CVFs has increased in recent years. Most commonly, patients harbor only 1 fistula at the time of myelography (although additional de novo fistulas can arise after treatment). Occasionally, 2 synchronous CVFs may be seen on a single myelogram. The coexistence of more than 2 CVFs, however, is quite rare and has only been previously described in 2 instances. Here, we present a multi-institutional series of 16 patients with 3 or more concurrently discovered CVFs, representing the largest cohort of such patients to date. We describe their clinical features, imaging findings, treatment approaches, and outcomes.