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O-034 Characterization of CSF-venous fistula venous drainage patterns and specific site of fistula origin: implications for transvenous embolization
  1. T Huynh,
  2. D Parizadeh,
  3. O Fermo
  1. Mayo Clinic Florida, Jacksonville, FL, USA
  2. Transvenous embolization of CSF-venous fistulae (CVF) associated with spontaneous intracranial hypotension (SIH) is an emerging highly efficacious and safe treatment. Venous drainage pattern and location of fistula associated with the CVF however may vary significantly and may have implications for embolization treatment planning including venous microcatheter navigation and targeting of embolic material. We sought to systematically characterize the CVF venous drainage patterns and specific sites of CVF origin.


Methods A retrospective review of SIH patients who underwent transvenous embolization of CSF-venous fistulas at our institution was reviewed. All patients were diagnosed with SIH based on clinical and/or imaging findings and had a definite diagnosis of CVF on dynamic CT myelogram. Venous drainage patterns were categorized into simple drainage pattern (i.e. draining into the foraminal venous plexus and adjacent segmental vein) and complex drainage pattern (i.e. draining into additional veins including intra-osseous, basivertebral/internal epidural venous plexus, adjacent level, or contralateral level veins). Fistulae origin were first categorized as arising directly from either the nerve root sleeve or adjacent diverticulum and location of origin relative to the sleeve or diverticulum. We also identified the location of the CVF origin relative to the ipsilateral pedicle and neural foramina given that these are common target landmarks to guide embolization.

Results Twenty-four CSF-venous fistulae in 23 patients were evaluated. Simple venous drainage pattern was seen in all cases; additional complex venous drainage pattern was visualized in 8 (33%) including 4 cases of intra-osseous venous drainage, 3 cases of adjacent level venous drainage, and 1 level draining to the contralateral side. The origin of the CVF was visualized in 23/24 (96%) of cases and was seen originating directly from the diverticulum in 15 (65%) and from the nerve root sleeve in 8 (35%). The CVF origin was located in the anterior neural foramina inferior to the pedicle in 14 (61%) and lateral to the pedicle/foramina in 9 (39%).

Conclusion CVF have varied venous drainage patterns which may have implications for both transvenous microcatheter navigation and embolization planning. Microcatheter positioning and embolization immediately under or just lateral to the pedicle and neural foramina is an ideal location to ensure occlusion of CVF origin in most cases.

Abstract O-034 Figure 1

Example of complex CSF-venous fistula drainage pattern including drainage into the basivertebral vein, intra-osseous, and dorsal muscular venous branches. The fistula originates directly from the nerve root sleeve without a significant diverticulum present

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

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