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Cerebrospinal fluid venous fistula: Illustrative case. Surg Neurol Int 2022;13:374

Date

09/22/2022

Pubmed ID

36128164

Pubmed Central ID

PMC9479572

DOI

10.25259/SNI_599_2022

Scopus ID

2-s2.0-85140035702 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Spinal cerebrospinal fluid (CSF) venous fistulas are an under-recognized cause for spontaneous intracranial hypotension (SIH) which may result in postural headaches.

CASE DESCRIPTION: A 60-year-old-male presented with 6 years of a persistent headache. The initial brain and spine MRIs and conventional CT myelogram (CTM) showed no CSF venous fistula. However, the lateral decubitus dynamic CTM demonstrated a hyperdense paraspinal vein on the right at the T10-11 level consistent with a CSF venous fistula. It was subsequently successfully treated with surgical ligation. Temporary CSF diversion with lumbar drain was required to treat transient rebound intracranial hypertension.

CONCLUSION: The diagnosis of a CSF venous fistulas is often missed on standard brain and spine MRI imaging, and conventional CTM. Dynamic CTM is a more effective modality to detect CSF venous fistulas. Surgical ligation is a safe and effective treatment option. Patients with long-standing SIH may encounter rebound intracranial hypertension after CSF venous fistula ligation and may require temporary CSF diversion.

Author List

Shlobin NA, Shahrestani S, Shabani S, Agarwal N, Tan L

Author

Saman Shabani MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin