PT  - JOURNAL ARTICLE
AU  - Donna Parizadeh
AU  - Antonio H C Vasconcelos
AU  - David A Miller
AU  - Olga P Fermo
AU  - Thien J Huynh
TI  - Dual microcatheter and coil/balloon pressure cooker technique for transvenous embolization of cerebrospinal fluid-venous fistulas
AID  - 10.1136/neurintsurg-2022-019005
DP  - 2023 Jun 01
TA  - Journal of NeuroInterventional Surgery
PG  - 614--614
VI  - 15
IP  - 6
4099  - http://jnis.bmj.com/content/15/6/614.short
4100  - http://jnis.bmj.com/content/15/6/614.full
SO  - J NeuroIntervent Surg2023 Jun 01; 15
AB  - 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 Technical video demonstrating dual-microcatheter and coil/balloon pressure cooker technique.