Cerebrospinal fluid–venous fistula (CSFVF) is an increasingly recognized cause of spontaneous intracranial hypotension (SIH). We present a rare case of a 41-year-old woman with SIH caused by a right S2-S3 CSFVF draining in the right internal iliac vein. Successfully transvenous endovascular embolization using Onyx was performed. This report highlights diagnostic challenges and procedural details, emphasizing the efficacy of endovascular approaches in managing CSFVF in atypical anatomical locations.
SchievinkWIMayaMMJean-PierreS, et al.A classification system of spontaneous spinal CSF leaks. Neurology2016; 87: 673–679. [published Online First: 20160720].
2.
GibbyJTAmrheinTJYoungDS, et al.Diagnostic yield of decubitus CT myelography for detection of CSF-venous fistulas. AJNR Am J Neuroradiol2024; 45: 1597–1604. [published Online First: 20241003].
3.
BrinjikjiWMadhavanAGarzaI, et al.Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization. J Neurointerv Surg2024; 16: 1256–1263.
4.
MarkITMorrisPPBrinjikjiW, et al.Sacral CSF-venous fistulas and potential imaging techniques. AJNR Am J Neuroradiol2022; 43: 1824–1826. [published Online First: 20221103].
5.
CagnazzoFDucrosARisiG, et al.Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension. Interv Neuroradiol2024: 15910199241247698. [published Online First: 20240423].
6.
CagnazzoFLe BarsERisiG, et al.Early brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension. J Neurointerv Surg2025. [published Online First: 20250213]
7.
KranzPGAmrheinTJGrayL. CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol2017; 209: 1360–1366. [published Online First: 20171012].
8.
LutzenNAlemanEBEl RahalA, et al. Sacral dural tears as a cause of spontaneous intracranial hypotension. Clin Neuroradiol2023; 33: 957–964. published Online First: 20230601.
9.
ParizadehDFermoOVibhuteP, et al.Transvenous embolization of cerebrospinal fluid-venous fistulas: independent validation and feasibility of upper-extremity approach and using dual-microcatheter and balloon pressure cooker technique. J Neurointerv Surg2023; 15: 1234–1241. published Online First: 20230123.
