Cerebrospinal fluid venous fistula: Illustrative case. Surg Neurol Int 2022;13:374
Date
09/22/2022Pubmed ID
36128164Pubmed Central ID
PMC9479572DOI
10.25259/SNI_599_2022Scopus 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.