Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization

Abstract

BackgroundWe report outcomes of spontaneous intracranial hypotension (SIH) patients who underwent transvenous embolization of cerebrospinal fluid-venous fistulas (CSFVFs) confirmed on digital subtraction myelography (DSM) performed at our institution.MethodsThis is a retrospective evaluation of a prospectively collected database of SIH patients who underwent transvenous embolization of CSFVFs. Only patients who had fistulas confirmed on DSM performed at our institution were included. All patients had a baseline MRI and an MRI performed at least 90 days post-embolization, as well as clinical evaluation using the six item Headache Impact Test (HIT-6) and the Patient Global Impression of Change (PGIC) scales. Paired t-test was used to report changes in Bern MRI scores and HIT-6 scores at follow-up.Results40 patients were included (29 female, 11 male). Mean age was 57.4±10.3 years. Mean Bern score improved from 5.7±3.0 at baseline to 1.3±2.0 at follow-up (p<0.0001). Mean HIT-6 score at baseline was 67.2±11.1 and at follow-up was 41.5±10.1 (p<0.0001). Median PGIC was 1, with 36 patients (90.0%) reporting at least minimal improvement and 32 patients (82.5%) reporting much or very much improvement. Complications included persistent local site pain in 12 patients (30%), suspected rebound intracranial hypertension requiring medical intervention in 7 patients (17.5%), and asymptomatic tiny Onyx emboli to the lungs in 3 patients (7.5%).ConclusionsTransvenous embolization of CSFVFs using Onyx is safe and effective, resulting in significant improvement in headache and overall clinical outcomes in nearly 90% of patients, and substantial improvements in brain MRI abnormalities.

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

“…The mean pre‐ and posttreatment Bern SIH scores were 5.9 and 1.5, respectively, which is similar to another study with patients with CVFs treated with endovascular embolization (5.7 and 1.3) 6 . Our improved imaging scores were also in keeping with the improved clinical and myelographic findings.…”

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

“…The mean pre‐ and posttreatment Bern SIH scores were 5.9 and 1.5, respectively, which is similar to another study with patients with CVFs treated with endovascular embolization (5.7 and 1.3) 6 . Our improved imaging scores were also in keeping with the improved clinical and myelographic findings.…”

Spontaneous Spinal CSF Leaks Stratified by Age, Body Mass Index, and Spinal Level

“…Last, type 3 spinal leaks were most common on the right side and the lower thoracic spine. This laterality and spinal location correspond to information in another study, 22 but a separate study has reported more CVFs on the left side. 21 Type 2 spinal CSF leaks were the least common in our patient population.…”

Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: Case-series

“…More recently, transvenous embolization has been described with low risk and excellent clinical and radiographic outcomes. [4][5][6] The presented case series demonstrated "real-world" efficacy of CSF-venous fistula embolization, further validating the findings of studies published by highvolume practices.…”

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

“…The mean pre‐ and posttreatment Bern SIH scores were 5.9 and 1.5, respectively, which is similar to another study with patients with CVFs treated with endovascular embolization (5.7 and 1.3) 6 . Our improved imaging scores were also in keeping with the improved clinical and myelographic findings.…”

Spontaneous Spinal CSF Leaks Stratified by Age, Body Mass Index, and Spinal Level

“…Last, type 3 spinal leaks were most common on the right side and the lower thoracic spine. This laterality and spinal location correspond to information in another study, 22 but a separate study has reported more CVFs on the left side. 21 Type 2 spinal CSF leaks were the least common in our patient population.…”

Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: Case-series

“…More recently, transvenous embolization has been described with low risk and excellent clinical and radiographic outcomes. [4][5][6] The presented case series demonstrated "real-world" efficacy of CSF-venous fistula embolization, further validating the findings of studies published by highvolume practices.…”

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

“…The mean pre‐ and posttreatment Bern SIH scores were 5.9 and 1.5, respectively, which is similar to another study with patients with CVFs treated with endovascular embolization (5.7 and 1.3) 6 . Our improved imaging scores were also in keeping with the improved clinical and myelographic findings.…”

Spontaneous Spinal CSF Leaks Stratified by Age, Body Mass Index, and Spinal Level

“…Last, type 3 spinal leaks were most common on the right side and the lower thoracic spine. This laterality and spinal location correspond to information in another study, 22 but a separate study has reported more CVFs on the left side. 21 Type 2 spinal CSF leaks were the least common in our patient population.…”

Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: Case-series

“…More recently, transvenous embolization has been described with low risk and excellent clinical and radiographic outcomes. [4][5][6] The presented case series demonstrated "real-world" efficacy of CSF-venous fistula embolization, further validating the findings of studies published by highvolume practices.…”