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Published on: January 27, 2015

Mechanisms of Local CSF-Venous Fistula Persistence after Transvenous Embolization for Spontaneous Intracranial

Derrek Schartz1, Nicholas T Befera2, Michael D Malinzak2

  • 1From the Department of Radiology (D.S., N.T.B., M.D.M., J.W., L.G., T.J.A., P.G.K., A.A.M.), Duke University Medical Center, Durham, North Carolina, USA; Department of Neurosurgery (M.T.B.), University of Rochester Medical Center, and Radiology (M.L.K.), Mayo Clinic, Rochester,MN, USA. derrek.schartz@duke.edu.

AJNR. American Journal of Neuroradiology
|June 12, 2026
PubMed

Insights

Recurrent cerebrospinal fluid-venous fistulas (CVF) after transvenous embolization (TVE) stem from two main mechanisms: fistulas at the Onyx cast margin or inadequate occlusion of the internal epidural venous plexus.

Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Cerebrospinal fluid-venous fistulas (CVF) cause spontaneous intracranial hypotension (SIH).
  • Transvenous embolization (TVE) is a primary treatment for CVF.
  • Symptomatic recurrence occurs in ~8% of patients post-TVE due to local CVF persistence.

Purpose of the Study:

  • To investigate the mechanisms of local cerebrospinal fluid-venous fistula (CVF) persistence after transvenous embolization (TVE).
  • To identify reasons for symptomatic recurrence in patients treated for CVF.

Main Methods:

  • Retrospective analysis of 10 patients with local CVF persistence/recurrence after TVE.
  • Detailed examination of fistula location relative to the embolization cast and venous plexus occlusion.

Main Results:

  • Two primary mechanisms for CVF persistence were identified.
  • Mechanism 1: Fistulas at the Onyx cast margin (external venous plexus or basivertebral vein).
  • Mechanism 2: Inadequate occlusion of the internal epidural venous plexus, not necessarily at the cast's distal end.

Conclusions:

  • Understanding these mechanisms can optimize TVE techniques for CVF treatment.
  • This knowledge aids in localizing persistent CVF in recurrent cases, improving patient management.

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