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Percutaneous Treatment and Post-treatment Management of CSF Leaks and CSF-Venous Fistulas in Spontaneous Intracranial

Jessica L Houk1, Peter G Kranz1, Timothy J Amrhein1

  • 1Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Box 3808, Durham, NC 27710, USA.

Neurosurgery Clinics of North America
|October 30, 2025
PubMed

Insights

Spontaneous intracranial hypotension (SIH) causes disabling headaches due to cerebrospinal fluid (CSF) loss. This review details percutaneous treatments and post-procedure care for SIH, offering alternatives to standard therapies.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Spontaneous intracranial hypotension (SIH) is a treatable condition causing orthostatic headaches due to cerebrospinal fluid (CSF) loss.
  • Known causes include dural tears, nerve root sleeve diverticula, and CSF-venous fistulas (CVFs).
  • While surgical and endovascular repairs exist, epidural blood patching (EBP) is a common first-line treatment.

Purpose of the Study:

  • To review the indications and techniques for percutaneous treatment of SIH.
  • To provide an overview of post-procedural management for patients with SIH.

Main Methods:

  • Literature review focusing on percutaneous interventions for SIH.
  • Analysis of techniques and outcomes for epidural blood patching and other minimally invasive procedures.
  • Discussion of diagnostic modalities and management strategies.

Main Results:

  • Epidural blood patching (EBP) is a widely used, relatively low-risk first-line therapy for SIH.
  • Percutaneous treatments offer definitive repair options for specific types of CSF leaks.
  • Management strategies are tailored to the underlying cause and patient presentation.

Conclusions:

  • Percutaneous interventions are valuable treatment options for SIH, complementing traditional therapies.
  • Effective management requires accurate diagnosis of the CSF leak source.
  • Post-procedural care is crucial for successful patient outcomes in SIH treatment.

Keywords:
CSF-Venous fistulaCerebrospinal fluid leakEpidural blood patchingRebound intracranial hypertensionSpontaneous intracranial hypotension

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