Cerebrospinal fluid-venous fistula: local experience with an increasingly common entity

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Cerebrospinal fluid (CSF)-venous fistulas involve abnormal connections between the spinal subarachnoid space and the epidural venous system.
• These fistulas are increasingly recognized as a treatable cause of spontaneous intracranial hypotension (SIH).

Purpose of the Study:

• To present a case series on the outcomes of endovascular and surgical management of CSF-venous fistulas in an Australian cohort.
• To highlight the efficacy of early diagnosis and treatment for SIH caused by CSF-venous fistulas.

Main Methods:

• A retrospective review of five patients with CSF-venous fistulas treated over twelve months.
• Treatments included surgical ligation of the nerve root or endovascular occlusion of the venous plexus.
• Clinical and radiological outcomes were assessed.

Main Results:

• Three patients underwent surgical ligation, and two had endovascular occlusion.
• All five patients achieved complete symptom resolution at follow-up.
• Patients with subdural hematomas showed significant radiological improvement or resolution.

Conclusions:

• CSF-venous fistulas are a readily treatable cause of SIH.
• Both surgical and endovascular approaches offer excellent outcomes.
• Early recognition and prompt treatment are crucial for favorable results.