Introduction With promising reports of the short-term outcomes of endovascular transvenous embolization, this technique is now recognized as a highly efficient and safe treatment for patients with spontaneous intracranial hypotension (SIH) secondary to CSF-venous fistulas (CVF). Long-term efficacy beyond 3 months remains poorly described in the literature. We sought to investigate the one-year imaging and clinical outcomes of this procedure.

Methods A retrospective review of patients who underwent transvenous embolization of CSF-venous fistulas at our institution was reviewed. Patients treated between December 2020 and March 2023 were included. All patients were diagnosed with SIH based on clinical and/or imaging findings and had a definite diagnosis of CVF on lateral decubitus digital subtraction or dynamic CT myelogram. Pre-and long-term, 1-year, post-embolization clinical evaluation and brain MRI findings including the Bern SIH score were recorded and long-term post-procedural complications were reviewed.

Results During the study period, 18 patients underwent the procedure. Long-term follow-up was available for 13 patients, with median (IQR) age 61 (50 - 65) years and 62% female. Median (IQR) follow-up was 12 (10-13) months for clinical (available for 13/13 patients) and 11 (7-13) months for imaging outcomes, available for 13 and 10 patients, respectively. 10/13 (77%) patients had sustained clinical improvement, 2/13 (15%) had recurrence of symptoms due to a new leak from a new site (n = 1) or the previously embolized site (n = 1), and 1/13 (8%) did not respond to treatment. Patients also had sustained imaging improvement with a pre-embolization median (IQR) Bern SIH score of 7 (8-8) improving to 2.5 (3-4) at 3-month and 1.5 (2-3) at 1-year follow-up. There were no long-term complications. Short-term side effects were localized back pain (76%) and rebound headache (46%) which resolved in the long-term follow-up for all patients.

Conclusion Transvenous embolization has high efficacy and safety in the long-term and can be considered a durable treatment for SIH patients with CVF. A small proportion of patients may however develop new leaks which require further evaluation and treatment.

• Download figure
• Open in new tab
• Download powerpoint

Abstract O-032 Figure 1

Imaging of a patient in their 40s diagnosed spontaneous intracranial hypotension before and after transvenous embolization of a CSF-venous fistula (CVF) at right T10. Pre-embolization sagittal T1-weighted MRI (A) shows severe midbrain sagging and low-lying cerebellar tonsils before embolization of CVF at right T10 (B) Short-term follow-up MRI at 3-months (C) and long-term follow-up MRI at 13 months (D) show sustained improvement of imaging findings which was concordant with sustained resolution of symptoms

Disclosures D. Parizadeh: None. O. Fermo: None. K. Brewer: None. T. Huynh: None.