Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension
Fédérico Cagnazzo, Anne Ducros, Gaetano Risi, Mahmoud Charif, Lucas Corti, Francesca Rapido, Emmanuelle Le Bars, Nicolas Lonjon, Vincent Costalat
Abstract
Background Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH). Methods Participants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described. Results Twenty-one consecutive patients (median age 63 years, IQR = 58–71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively ( p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) ( p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) ( p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) ( p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) ( p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%. Conclusion Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.