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Transvenous embolization of a cerebrospinal fluid–venous fistula for the treatment of spontaneous intracranial hypotension
  1. Nicholas Borg1,
  2. Soliman Oushy1,
  3. Luis Savastano1,
  4. Waleed Brinjikji2
  1. 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Nicholas Borg, Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA; borg.nicholas{at}


Cerebrospinal fluid–venous fistula is an increasingly recognized cause of spontaneous intracranial hypotension.1 The site of the leak is between the dural sleeve around a spinal nerve root and the surrounding foraminal veins. In appropriately investigated patients, transvenous embolization of the draining foraminal and paraspinal veins has been shown to be an effective way of treating the disease, with low periprocedural morbidity, improvement in symptoms and radiological appearances.2 Video 1 shows the technique employed in a typical case using Onyx (Medtronic, Minnesota, USA) to embolize a CSF–venous fistula at the right T10 neural foramen.

Video 1

  • intracranial pressure
  • spinal nerve
  • vein
  • technique
  • fistula

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  • Contributors All authors contributed equally to the production of this technical video and its associated abstract.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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