Fistula, CSF-Venous
CSF-venous fistula could be a cause of intracranial hypotension. Endovascular transvenous fistula embolization (Case 1) could be effective in treating this disease.[1]
Cases
1
This patient presented with progressively worsening headaches. Brain MRI with and without contrast suggested intracranial hypotension with bilateral subdural hygromas (A), diffuse pathymeningeal enhancement (B, C, and D), and crowded foramen magnum (E). MRI neuraxis with and without contrast also showed diffuse dural enhancement (not shown) without an identifiable CSF leak. A CT myelogram showed contrast extravasation within the left neural foramen at C7-T1 (F and G), suspecting a CSF-venous fistula. The patient subsequently underwent a diagnostic venogram (H and I) and Onyx embolization of the left C7-T1 paraspinal venous network (J and K).
Intervention Specifics:
- Access: right common femoral vein, 6F sheath
- Guide catheter: Benchmark, 90 cm
- Select catheter: DAV
- Wire: Glidewire, 0.038
- Microcatheter: Headway DUO
- Microwire: Synchro-2
- Embolic material: Onyx 18
* This case is also published in note Intracranial Hypotension.