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Dual microcatheter and coil/balloon pressure cooker technique for transvenous embolization of cerebrospinal fluid-venous fistulas
  1. Donna Parizadeh1,
  2. Antonio H C Vasconcelos2,
  3. David A Miller1,
  4. Olga P Fermo3,
  5. Thien J Huynh1
  1. 1 Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
  2. 2 Health Sciences Center, University of Fortaleza, Fortaleza, CE, Brazil
  3. 3 Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Thien J Huynh, Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA; huynh.thien{at}


Cerebrospinal fluid-venous fistula is increasingly recognized as a cause of spontaneous intracranial hypotension.1 Transvenous embolization is emerging as an efficacious minimally invasive treatment.2–4 The procedure aims to embolize paraspinal and foraminal veins draining the fistula; however, complete embolization may be challenging as numerous small venous tributaries at the foraminal venous plexus, including dorsal muscular branches, may serve as additional routes of cerebrospinal fluid egress.5 To ensure curative embolization, we adopted a dual microcatheter pressure cooker technique, previously used for treatment of brain arteriovenous malformations.6 This allows improved control of embolic material reflux and greater chance of complete embolization of the site of the fistula and all potential venous tributaries. Video 1 demonstrates this technique employed in a typical case using Onyx (Medtronic, Minnesota, USA) to embolize a cerebrospinal fluid-venous fistula at the left L1 neural foramen.

Video 1 Technical video demonstrating dual-microcatheter and coil/balloon pressure cooker technique.
  • Balloon
  • Coil
  • Embolic
  • Fistula

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  • Contributors DP drafted abstract, prepared, and narrated the video. TJH carried out the procedure and directed the script. AHCV prepared the video. All authors critically revised the content and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.