BackgroundTransvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH).MethodsParticipants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described.ResultsTwenty-one consecutive patients (median age 63 years, IQR = 58–71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively ( p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) ( p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) ( p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) ( p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) ( p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%.ConclusionTransvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.

中文翻译：

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经静脉栓塞脑脊液-静脉瘘治疗自发性低颅压患者的安全性和有效性

背景经静脉栓塞是脑脊液静脉瘘 (CSFVF) 的最新治疗策略，脑脊液静脉瘘 (CSFVF) 与自发性颅内低血压 (SIH) 相关。方法参与者选自接受经静脉 Onyx 栓塞的 CSFVF 患者的前瞻性数据库。所有患者在栓塞前后均接受脑部磁共振成像 (MRI)，并在治疗后至少 3 个月进行 MRI 随访。描述了治疗后的临床和 MRI 结果。 结果 纳入 21 名连续患有 30 例 CSFVF 的患者（中位年龄 63 岁，IQR = 58-71；女性：15/21 = 71.5%）。大多数病变位于 T9 和 L1 之间（19/30 = 63%），70% 位于右侧，38% 的患者有多发性瘘管。所有病例的栓塞治疗均成功。治疗前后的平均 MRI SIH 评分分别为 6 (±2.5) 和 1.4 (±1.6) (p < 0.0001)。 20 名患者 (90%) 的初始状况有所改善，其中 67% 报告完全临床康复。平均 HIT-6 评分从 67 (±15) 下降到 38 (±9) (p < 0.0001)，每月平均头痛天数从 23.5 (±10) 下降到 3.2 (±6.6) (p < 0.0001)，头痛严重程度的视觉评估量表 (VAS) 从 8 (±1.9) 提高到 1.2 (±2) (p < 0.0001)，感知生活质量的平均 VAS 从 2.6 (±2.5) 提高到 8.6 (±1.8) （p<0.0001）。没有出现重大并发症。治疗后疑似反跳性头痛发生率为 33%。结论 CSFVF 经静脉栓塞治疗可实现较高的临床改善率，且无与治疗相关的发病率。