open access
Recurrence of cerebrospinal fluid-venous fistulas at different spinal levels following transvenous embolisation or blood/fibrin glue patching
, 1, 2
Affiliations- Department of Neurology, Mayo Clinic, Jacksonville, Florida, United States
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, United States
open access
Abstract
Aim of the study. This study presents cases of recurrent cerebrospinal fluid-venous fistulas (CVFs) de novo at a different spinal level following successful treatment of initial CVFs. The aim was to highlight this rarely described phenomenon and report the clinical and imaging features after initial treatment, providing insights into the dynamics of recurrent CVFs.
Clinical rationale for the study. Understanding the course of CVFs post-treatment is crucial for optimising patient management, especially when symptoms persist or recur.
Material and methods. We performed a retrospective chart review of all patients with recurrent CVFs at a different level after treatment of their initial CVF at our institution. Clinical and imaging records were reviewed and summarised, including Bern score features on brain magnetic resonance imaging (MRI) before and after treatment.
Results. Four patients with five recurrent CVFs were identified. Recurrent or persistent symptoms encouraged subsequent brain MRI scans, which revealed different outcomes: i.e. persistence, or improvement, or complete resolution of abnormal findings. Initial positive responses included improvement of the pachymeningeal enhancement and venous sinus distension. These improvements were reversed when recurrent symptoms arose, which was also correlated with changes in the Bern score.
Conclusions and clinical implications. Recognising the factors of CVF recurrence is crucial for comprehensive management. This study underlines the significance of repeated evaluation of persistent or recurring symptoms of CSF leak after treatment for CVFs.
Abstract
Aim of the study. This study presents cases of recurrent cerebrospinal fluid-venous fistulas (CVFs) de novo at a different spinal level following successful treatment of initial CVFs. The aim was to highlight this rarely described phenomenon and report the clinical and imaging features after initial treatment, providing insights into the dynamics of recurrent CVFs.
Clinical rationale for the study. Understanding the course of CVFs post-treatment is crucial for optimising patient management, especially when symptoms persist or recur.
Material and methods. We performed a retrospective chart review of all patients with recurrent CVFs at a different level after treatment of their initial CVF at our institution. Clinical and imaging records were reviewed and summarised, including Bern score features on brain magnetic resonance imaging (MRI) before and after treatment.
Results. Four patients with five recurrent CVFs were identified. Recurrent or persistent symptoms encouraged subsequent brain MRI scans, which revealed different outcomes: i.e. persistence, or improvement, or complete resolution of abnormal findings. Initial positive responses included improvement of the pachymeningeal enhancement and venous sinus distension. These improvements were reversed when recurrent symptoms arose, which was also correlated with changes in the Bern score.
Conclusions and clinical implications. Recognising the factors of CVF recurrence is crucial for comprehensive management. This study underlines the significance of repeated evaluation of persistent or recurring symptoms of CSF leak after treatment for CVFs.
Keywords
cerebrospinal fluid-venous fi stula, spontaneous intracranial hy potension, Be rn score, re currence, my elography, embolisation, patch
About this articleTitle
Recurrence of cerebrospinal fluid-venous fistulas at different spinal levels following transvenous embolisation or blood/fibrin glue patching
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
54-59
Published online
2024-01-31
Page views
469
Article views/downloads
315
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2024;58(1):54-59.
Keywords
cerebrospinal fluid-venous fi stula
spontaneous intracranial hy potension
Be rn score
re currence
my elography
embolisation
patch
Authors
Roaa Zayat
Olga P. Fermo
Thien J. Huynh
References (5)- Roytman M, Salama G, Robbins MS, et al. CSF-venous fistula. Curr Pain Headache Rep. 2021; 25(1): 5.
- Schievink WI, Maya M, Prasad RS, et al. Spontaneous spinal cerebrospinal fluid-venous fistulas in patients with orthostatic headaches and normal conventional brain and spine imaging. Headache. 2021; 61(2): 387–391.
- Sobczyk P, Bojarski P, Sobstyl M. Surgical management of spontaneous intracranial hypotension syndrome: a literature review. Neurol Neurochir Pol. 2023; 57(2): 151–159.
- Dobrocky T, Grunder L, Breiding PS, et al. Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 2019; 76(5): 580–587.
- Malinzak MD, Kranz PG, Gray L, et al. Postsurgical Recurrence of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension. Neurol Clin Pract. 2021; 11(3): e356–e358.
