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

Cerebrospinal fluid (CSF)-venous fistulas have been described as a fistulous connection between the spinal subarachnoid space, typically in a thoracic nerve root sheath, and the epidural venous system. They have become increasingly reported as a treatable entity in patients with spontaneous intracranial hypotension (SIH). Here we present our case series with a focus on the outcomes of endovascular and surgical management, the first in an Australian cohort.

Five cases of CSF-venous fistulas were identified and treated over a twelve-month period at two tertiary neurosurgical centres in Melbourne, Victoria. Clinical outcomes measured were clinical improvement in symptoms and radiological improvement.

Of the five cases, three underwent treatment via surgical ligation of the symptomatic nerve root and two patients via endovascular occlusion of the venous plexus at the level of interest. All patients were symptom free at the time of their most recent follow-up. Of the patients who presented with bilateral subdural haematomas, all were demonstrating progressive radiological improvement or resolution.

CSF-venous fistulas are a readily treatable cause of SIH. Our case series highlights the importance of early recognition and treatment, with excellent results with both surgical and endovascular treatment.