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Dual microcatheter and coil/balloon pressure cooker technique for transvenous embolization of cerebrospinal fluid-venous fistulas
  1. Donna Parizadeh1,
  2. Antonio H C Vasconcelos2,
  3. David A Miller1,
  4. Olga P Fermo3,
  5. Thien J Huynh1
  1. 1Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
  2. 2Health Sciences Center, University of Fortaleza, Fortaleza, CE, Brazil
  3. 3Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Thien J Huynh, Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA; huynh.thien{at}mayo.edu

Abstract

Cerebrospinal fluid-venous fistula is increasingly recognized as a cause of spontaneous intracranial hypotension.1 Transvenous embolization is emerging as an efficacious minimally invasive treatment.2–4 The procedure aims to embolize paraspinal and foraminal veins draining the fistula; however, complete embolization may be challenging as numerous small venous tributaries at the foraminal venous plexus, including dorsal muscular branches, may serve as additional routes of cerebrospinal fluid egress.5 To ensure curative embolization, we adopted a dual microcatheter pressure cooker technique, previously used for treatment of brain arteriovenous malformations.6 This allows improved control of embolic material reflux and greater chance of complete embolization of the site of the fistula and all potential venous tributaries. Video 1 demonstrates this technique employed in a typical case using Onyx (Medtronic, Minnesota, USA) to embolize a cerebrospinal fluid-venous fistula at the left L1 neural foramen.

Video 1

Disclaimer: this video summarises a scientific article published by BMJ Publishing Group Limited (BMJ). The content of this video has not been peer-reviewed and does not constitute medical advice. Any opinions expressed are solely those of the contributors. Viewers should be aware that professionals in the field may have different opinions. BMJ does not endorse any opinions expressed or recommendations discussed. Viewers should not use the content of the video as the basis for any medical treatment. BMJ disclaims all liability and responsibility arising from any reliance placed on the content.

  • Balloon
  • Coil
  • Embolic
  • Fistula

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Footnotes

  • Twitter @donnaprzd, @thienhuynh15

  • Contributors DP drafted abstract, prepared, and narrated the video. TJH carried out the procedure and directed the script. AHCV prepared the video. All authors critically revised the content and approved the final version.

  • 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.

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