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Rates of Retreatment after Transvenous Embolization of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension
Derrek Schartz1, Nicholas T Befera2, Timothy J Amrhein2
1From the Department of Radiology (D.S., N.T.B., T.J.A., J.W., L.G., A.A.M., M.D.M., P.G.K.), Duke University Medical Center (S.C.), Duke University School of Medicine, Durham, North Carolina, USA. derrek.schartz@duke.edu.
Insights
About 23% of patients with cerebrospinal fluid-venous fistulas (CVF) require retreatment after transvenous embolization (TVE). Symptoms often recur within 3 months, with fistulas appearing at new locations.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Cerebrospinal fluid-venous fistulas (CVF) are a cause of spontaneous intracranial hypotension (SIH).
- Transvenous embolization (TVE) is an effective treatment for CVF, but retreatment may be necessary.
- Understanding recurrence patterns is crucial for patient management.
Purpose of the Study:
- To determine the rate of retreatment for CVF after TVE.
- To identify the anatomical location and timing of CVF recurrence or retreatment.
- To provide data for patient counseling and managing treatment expectations.
Main Methods:
- Retrospective cohort study of 100 consecutive patients treated with TVE for CVF.
- Analysis of retreatment rates, symptom onset timing, and CVF location.
- Categorization of recurrent CVF sites relative to the initial treatment.
Main Results:
- 23% of patients required retreatment for persistent or recurrent symptoms.
- Most recurrences (74%) occurred within 3 months post-TVE.
- Recurrent CVFs included same-site (35%), adjacent (30%), and remote (35%) locations.
Conclusions:
- A significant portion of patients (23%) need retreatment after TVE for CVF.
- Early recurrence (within 3 months) is common.
- CVF recurrence can result from local failure or new fistula formation at distant sites, necessitating careful follow-up and patient education.
Background And Purpose:
Cerebrospinal fluid-venous fistulas (CVF) cause spontaneous intracranial hypotension (SIH) and can be treated with transvenous embolization (TVE). Although TVE has been shown to result in substantial symptomatic improvement, some patients may require retreatment. The purpose of this study was to clarify the rate, anatomical location, and timing of CVF recurrence/retreatment after TVE.
Materials And Methods:
Single center, retrospective cohort of consecutive patients with CVF who were treated with TVE. The rate of retreatment after TVE was determined. In addition, timing of symptom onset and location of recurrent CVF was recorded.
Results:
One hundred consecutive patients (65% female, mean age 59.3 years) with 105 CVFs treated with TVE were included. Overall, 23% (23/100) of patients required retreatment due to persistence or recurrence of symptoms. Most retreatment patients (74%, 17/23) had persistent or recurrent symptoms within 3 months after TVE. Approximately one third of patients needing retreatment (35%, 8/23) had a CVF at the same site and level as the initial CVF after having been embolized. Approximately one third (30%, 7/23) had a recurrent CVF adjacent to the initial CVF (defined as one level above, one level below, or at the same level but on the contralateral side). The remaining patients (35%, 8/23) had a CVF remote from the original fistula site.
Conclusions:
Approximately 23% of patients with CVF that are treated with TVE will require retreatment. Symptom recurrence is most common within 3 months after initial treatment. Recurrence can occur due to local treatment failure or development of collateral drainage pathways, but a substantial proportion of patients develop de novo CVFs remote from the initial treatment site. These findings can be used to counsel patients and to manage treatment expectations.
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