Spontaneous spinal cerebrospinal fluid venous-fistula treated with transvenous embolization: A case report
- Department of Neurosurgery, University of Washington, Seattle, Washington, United States,
- Department of Medicine, Firat University, Elazig, Turkey,
- Department of Medicine, University of Paris, Paris, France,
- Department of Radiology, Univ of Washington, Seattle, Washington, United States.
Zaid Aljuboori, Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
DOI:10.25259/SNI_878_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Zaid Aljuboori1, Margaret McGrath1, Muhammed Amir Essibayi2, Saif Zaidi3, Danial Hallam4, Basavaraj Ghodke4. Spontaneous spinal cerebrospinal fluid venous-fistula treated with transvenous embolization: A case report. 30-Sep-2021;12:492
How to cite this URL: Zaid Aljuboori1, Margaret McGrath1, Muhammed Amir Essibayi2, Saif Zaidi3, Danial Hallam4, Basavaraj Ghodke4. Spontaneous spinal cerebrospinal fluid venous-fistula treated with transvenous embolization: A case report. 30-Sep-2021;12:492. Available from: https://surgicalneurologyint.com/surgicalint-articles/11135/
Background: Spinal cerebrospinal fluid venous fistula (CVF) is a recognized cause of chronic positional headache and spontaneous intracranial hypotension (SIH). It occurs due to an aberrant connection formed between the spinal subarachnoid space and an adjacent spinal epidural vein. The diagnosis of CVF can be difficult to establish but can be documented utilizing advanced imaging techniques (e.g., enhanced MR myelography/digital subtraction myelography). Their treatment involves surgical ligation of the involved nerve root, imaging-guided epidural blood patching, and/or endovascular embolization. Here, we report a 40-year-old male who presented with a symptomatic lumbar CVF successfully treated with transvenous embolization.
Case Description: A 40-year-old male presented with several months of positional headaches. The MRI of the brain showed diffuse pachymeningeal enhancement consistent with the diagnosis of SIH. Although the MR of the lumbar spine was unremarkable, the MR myelogram with digital subtraction imaging showed a CVF at the L2 level. Following transvenous embolization (i.e., through the Azygous vein), the patient’s symptoms fully resolved.
Conclusion: Spinal CVF are rare and may cause chronic headaches and symptoms/signs of SIH. In this case, an MR myelogram with digital subtraction images demonstrated the anomalous connection between the spinal subarachnoid space and an adjacent spinal epidural vein at the L2 level. Although open surgical ablation of this connection may be feasible, less invasive techniques such as endovascular embolization should become the treatment of choice for the future management of CVF.
Keywords: Cerebrospinal fluid, Embolization, Fistula, Venous
Cerebrospinal fluid venous fistula (CVF) is defined as an aberrant connection formed between the spinal subarachnoid space and an adjacent spinal epidural veins allowing for the unregulated loss of cerebrospinal fluid into the circulatory system.[
A 40-year-old male presented with spontaneous onset of SIH characterized by positional headaches for several months. His neurological exam was normal. The enhanced MRI of the brain showed diffuse pachymeningeal enhancement consistent with SIH [
SIH patients are typically females in their 5th/6th decades.[
Levels of CVF
Most CVF are found in the thoracic spine; only a few cases are found in the cervical and lumbar regions.[
CVF, responsible for SIH, is best diagnosed utilizing MRmyelography/digital subtraction myelograms. Although direct surgical treatment may be successful, endovascular procedures are increasingly and less invasively effectively managing CVF Lesions.
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
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