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Abstract
Introduction Cerebrospinal fluid (CSF) venous fistulae pose a significant therapeutic challenge due to their complex diagnosis and varied treatment outcomes. Traditional treatments, such as epidural blood patches and surgical ligation, have been foundational yet occasionally limited in managing this condition. Recent advancements in endovascular techniques, particularly transvenous embolization via microcatheterization, offer a promising avenue for effective treatment. This technique’s innovative application, leveraging anatomical nuances for access, can be used to target CSF-venous fistulae through the spine. We present novel roadmaps for access particularly targeting CSF-venous fistulae in the upper thoracic region and cervicothoracic junction, areas previously deemed challenging. The purpose of this study is to present a series of 8 patients treated for CSF-venous fistulae utilizing novel transvenous access routes, not previously documented in the literature, emphasizing the importance of anatomical variability in improving treatment outcomes.
Methods This retrospective case series analyzes 8 patients diagnosed with CSF-venous fistulae, focusing on those located at the upper thoracic and cervicothoracic junction. Recognizing the anatomical anastomosis between the hemiazygos vein and the left renal vein as a potential access route, we explored novel endovascular pathways for embolization. The procedure involved accessing the left renal vein from the inferior vena cava (IVC), diverging from the standard approach that navigates from the superior vena cava (SVC) through the azygos system. The selection criteria, procedural details, embolization technique, and follow-up protocols are elaborated, providing a comprehensive overview of the methodology employed in addressing these fistulae.
Results Of the 8 patients treated using this innovative approach, significant improvement or resolution of symptoms was observed in all cases, with no major complications reported. This success underscores the viability of accessing the left renal vein as a safer and more effective route for embolizing fistulae in the upper thoracic and cervicothoracic junction. The case series demonstrates a 100% success rate in embolization procedures utilizing these novel transvenous access routes, highlighting the potential for enhanced patient outcomes through anatomically informed strategies.
Conclusions The findings from this case series suggest novel navigation in anatomically challenging regions. The use of the left renal vein for transvenous access offers an effective and safe alternative to traditional approaches in managing CSF-venous fistulae.
Disclosures J. Clarke: None. R. Meyer: None. M. Anderson: None. M. Walker: None. M. Levitt: 1; C; Medtronic, Stryker. 6; C; Proprio, Stroke Diagnostics, Synchron, Hyperion Surgical, Fluid Biomed, Apertur, Metis Innovative, Aeaean Advisers, Stereotaxis, Arsenal Medical. L. Kim: 2; C; Phillips North America. 4; C; Spi Surgical. B. Ghodke: None.