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Endovascular treatment of a sacral cerebrospinal fluid-venous Fistula using transvenous embolization: A case report

Federico Cagnazzo1, Andrés Ortiz Giraldo1, Nicolas Lonjon2

  • 1Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, France.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|January 27, 2026
PubMed

Insights

Cerebrospinal fluid-venous fistula (CSFVF) causes spontaneous intracranial hypotension (SIH). Successful transvenous embolization of a rare S2-S3 CSFVF demonstrates the efficacy of endovascular treatment for SIH.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Cerebrospinal fluid-venous fistula (CSFVF) is an emerging cause of spontaneous intracranial hypotension (SIH).
  • SIH can result from CSF leaks, often presenting diagnostic challenges.
  • CSFVF involves abnormal connections between CSF spaces and the venous system.

Purpose of the Study:

  • To report a rare case of SIH caused by a CSFVF.
  • To detail the diagnostic and interventional management of this rare condition.
  • To highlight the effectiveness of endovascular embolization for CSFVF in unusual locations.

Main Methods:

  • Case presentation of a 41-year-old woman with SIH.
  • Diagnostic workup including imaging to identify the CSFVF.
  • Transvenous endovascular embolization using Onyx as the primary treatment modality.

Main Results:

  • A right S2-S3 CSFVF draining into the right internal iliac vein was identified as the cause of SIH.
  • Successful transvenous embolization using Onyx was achieved.
  • The patient's SIH symptoms were effectively managed post-procedure.

Conclusions:

  • CSFVF is a significant, though underdiagnosed, cause of SIH.
  • Endovascular embolization is a viable and effective treatment for CSFVF, even in atypical anatomical locations.
  • This case underscores the importance of considering CSFVF in the differential diagnosis of SIH and highlights successful interventional management.

Keywords:
Cerebrospinal fluid venous fistulasacral CSF venous fistulaspontaneous intracranial hypotensiontransvenous embolization

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