Introduction Transvenous catheter Onyx (Ethylene vinyl alcohol copolymer) embolization is a new treatment option for CSF-venous fistulas (CVF), the most common cause of spontaneous intracranial hypotension.¹ CVF are abnormal connections between the thecal sac or nerve root sleeve and adjacent foraminal or epidural veins. Potential complications of CVF embolization including unintentional onyx migration into the lungs or subarachnoid space. The purpose of this study was the review post-procedure CT imaging of patients who have undergone transvenous embolization of CVF and evaluate the rate of pulmonary and subarachnoid onyx.

Method A retrospective analysis of 100 patients, 32 male, 68 female, mean age 59.2 years, in which post embolization CT were examined for onyx extravasation into the spine or lung. All patients received spinal venous embolization of CVF between 2020 and 2023 at Mayo Clinic Rochester.

Results Evaluation of post embolization CT of the cervical, thoracic, and lumbar spine, and lungs did not demonstrate any migration or extravasation of onyx.

Conclusion These findings provide valuable insight into the safety of transvenous onyx embolization of CVF. The lack of central reflux into the subarchnoid space suggests one-way CVF physiology.

Reference

1. Brinjikji W, Madhavan A, Garza I, et al. Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization. J Neurointerv Surg. Published online October 28, 2023. doi:10.1136/jnis-2023-021012.

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Abstract O-069 Figure 1

Disclosures C. Michaelcheck: None. W. Brinjikji: None. P. Cogswell: None. J. Benson: None. A. Madhavan: None. J. Verdoorn: None. J. Cutsforth-Gregory: None. I. Mark: None.