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New devices and techniques
Original research
Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization
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  1. Waleed Brinjikji1,2,
  2. Ivan Garza3,
  3. Mark Whealy3,
  4. Narayan Kissoon3,
  5. John L D Atkinson2,
  6. Luis Savastano3,
  7. Ajay Madhavan1,
  8. Jeremy Cutsforth-Gregory3
  1. 1 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Waleed Brinjikji, Mayo Clinic Minnesota, Rochester, MN 55901, USA; Brinjikji.Waleed{at}mayo.edu

Abstract

Background We report outcomes of spontaneous intracranial hypotension (SIH) patients who underwent transvenous embolization of cerebrospinal fluid-venous fistulas (CSFVFs) confirmed on digital subtraction myelography (DSM) performed at our institution.

Methods This is a retrospective evaluation of a prospectively collected database of SIH patients who underwent transvenous embolization of CSFVFs. Only patients who had fistulas confirmed on DSM performed at our institution were included. All patients had a baseline MRI and an MRI performed at least 90 days post-embolization, as well as clinical evaluation using the six item Headache Impact Test (HIT-6) and the Patient Global Impression of Change (PGIC) scales. Paired t-test was used to report changes in Bern MRI scores and HIT-6 scores at follow-up.

Results 40 patients were included (29 female, 11 male). Mean age was 57.4±10.3 years. Mean Bern score improved from 5.7±3.0 at baseline to 1.3±2.0 at follow-up (p<0.0001). Mean HIT-6 score at baseline was 67.2±11.1 and at follow-up was 41.5±10.1 (p<0.0001). Median PGIC was 1, with 36 patients (90.0%) reporting at least minimal improvement and 32 patients (82.5%) reporting much or very much improvement. Complications included persistent local site pain in 12 patients (30%), suspected rebound intracranial hypertension requiring medical intervention in 7 patients (17.5%), and asymptomatic tiny Onyx emboli to the lungs in 3 patients (7.5%).

Conclusions Transvenous embolization of CSFVFs using Onyx is safe and effective, resulting in significant improvement in headache and overall clinical outcomes in nearly 90% of patients, and substantial improvements in brain MRI abnormalities.

  • fistula
  • intracranial pressure
  • liquid embolic material

Data availability statement

No data are available. NA.

https://doi.org/10.1136/neurintsurg-2021-018466

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    Data availability statement

    No data are available. NA.

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    Footnotes

    • Contributors WB made substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of data as well as drafted the work and gave final approval of the published version and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JC-G, LS, JLDA, IG, NK and MW made substantial contributions to the acquisition, analysis and interpretation of data AND revised it critically for important intellectual content and gave final approval of the published version and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WB is responsible for the overall content and is the guarantor of the entire work. He accepts full responsibility for the work and conduct of the study, had access to the data and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests WB consultant for Medtronic, Microvention, Stryker, Cerenovus, MIVI. No other financial relationships.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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