• World Neurosurg · Jun 2023

    Clinical and Imaging Outcomes of Surgically Repaired Cerebrospinal Fluid-Venous Fistulas Identified by Lateral Decubitus Digital Subtraction Myelography.

    • Monique M Montenegro, Narayan R Kissoon, AtkinsonJohn L DJLDDepartment of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA., John C Benson, Waleed Brinjikji, Carrie M Carr, Jeremy K Cutsforth-Gregory, Ivan Garza, Tina M Gunderson, Dong Kun Kim, Greta B Liebo, Mark A Whealy, William L Lanier, and Jared T Verdoorn.
    • Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: monique.monten@gmail.com.
    • World Neurosurg. 2023 Jun 23.

    ObjectiveTo describe clinical and radiographic outcomes of surgical repair of cerebrospinal fluid-venous fistula (CVF), an increasingly recognized cause of spontaneous intracranial hypotension that is poorly responsive to epidural blood patch (EBP).MethodsRetrospective review identified adult patients who had lateral decubitus digital subtraction myelography indicative of cerebrospinal fluid leak at Mayo Clinic between November 2018 and February 2020, with clearly localized CVF, followed by surgical treatment. Patients without available imaging before or after surgery were excluded. History of EBP and clinical response to EBP were evaluated along with surgical outcomes.ResultsOf 25 patients with CVF who met protocol criteria and were included in the data analysis, 22 (88%) received EBP, but clinical benefit lasting ≥4 weeks occurred in only 2 of 22 (9%). Headache was the most prominent preoperative feature among patients (24/25; 96%). Following surgery, 18 of 24 (75%) patients had complete headache improvement, 4 (17%) had partial improvement, and 2 (8%) had no improvement. Ten of 25 (40%) patients reported cognitive disturbance at baseline; at follow-up, 5 of 10 (50%) had complete improvement, 3 (30%) had partial improvement, and 2 (20%) had no improvement. On postoperative brain magnetic resonance imaging, 6 of 25 (24%) patients had complete resolution of findings by Bern score criteria, 18 (72%) showed partial improvement, and 1 (4%) patient showed no improvement. Adverse events were minor and included surgical site pain and paresthesias.ConclusionsSurgical repair of CVF resulted in improvements in headache and other symptoms, with few side effects.Copyright © 2023 Elsevier Inc. All rights reserved.

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