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P024/228  Endovenous embolization for spontaneous intracranial hypotension (SIH) secondary to spinal cerebrospinal fluid-venous fistula (CSF-VF): case presentation and treatment outcome
  1. Si Zhao Tang,
  2. Gopinathan Anil
  1. National University Hospital (NUH) – Singapore, Division of Interventional Radiology, Department of Diagnostic Imaging, Singapore, Singapore


Introduction Spinal cerebrospinal fluid-venous fistula (CSF-VF) is being increasingly recognised as an important cause for spontaneous intracranial hypotension (SIH). Several studies have reported endovenous embolization as a safe and effective treatment option for CSF-VF.

Aim of Study We performed a systematic review on endovascular treatment for CSF-VF, followed by a case presentation and treatment outcome.

Methods A systematic search using combinations of keywords: [SPINAL] AND [CSF-VENOUS FISTULA] AND [ENDOVASCULAR] from inception to 1 April 2023 in PubMed was performed. For our case, patient had consented for research participation prior to endovascular treatment.

Results 5 studies reported endovascular treatment in patients with SIH secondary to spinal CSF-VF. There is significant disparity in case volume – 2 had 5 and 60 patients, whereas rest were single case reports. Clinical resolution/improvement were achieved in all cases with no reported periprocedural major adverse events or recurrence.

In our case, 56-year-old lady presented with intermittent postural headache for 6 months. MRI brain demonstrated SIH. Epidural blood patch was performed. However, her SIH recurred after 1 month. Digital subtraction myelography (DSM) and decubitus CT myelogram (CTM) demonstrated CSF-VF at right T9–10 neural exit foramen. Onyx embolization was performed with good penetration and desirable cast distribution. No periprocedural complication was encountered. Complete radiological and clinical resolution of SIH were achieved with no recurrence.

Conclusion SIH from spinal CSF-VF is an emerging entity that is increasingly recognized, which endovascular venous embolization is an effective and safe treatment option for this disease.

Disclosure of Interest Nothing to disclose.

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