Successful endovascular treatment of a spontaneous dorsal cerebrospinal fluid venous fistula: A case report

Abstract

Introduction

Spontaneous cerebrospinal fluid (CSF) leaks, though rare, can cause significant neurological symptoms such as positional headaches and tinnitus, often due to thoracic spinal dural venous fistulas. This report describes a case of a dorsal spinal CSF venous fistula with symptom improvement after endovascular treatment.

Methods

Following the CARE guidelines, key clinical data, including imaging, intervention, and follow-up outcomes, were collected. Informed consent was obtained.

Case Presentation

A 42-year-old female with a one-year history of positional headaches and tinnitus showed a CSF collection from D1 to D6 on imaging, with a suspected fistula at D5–D6. Conservative treatments failed, and the patient underwent endovascular embolization at D6, resulting in symptom improvement. Subsequent imaging identified a minor leak at L2, managed with follow-up. By January 2024, her headaches had resolved, and she resumed physical activities without recurrence.

Conclusion

This case highlights the effectiveness of endovascular embolization for treating CSF venous fistulas, achieving significant symptom relief and returning to normal activities. Early diagnosis, imaging, and intervention are essential for managing these leaks and preventing complications, with regular follow-up critical for long-term recovery.