Abstract Details

Title Cure for the Uncommon CSF Leak: Surgical Outcomes of CSF-Venous Fistula Repair

Topic Headache

Presentation(s) Headache Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 080

Background CSF-venous fistulas are an uncommon cause of spontaneous intracranial hypotension (SIH) that is usually unresponsive or poorly responsive to epidural blood patch (EBP). Surgical ligation of the nerve root and associated vessels has been successfully utilized as a method to treat CSF-venous fistulas. The full spectrum of neurological symptom outcomes has not been described.

Objective To describe surgical outcomes of CSF-venous fistula repair defined by effect on neurologic symptoms of spontaneous intracranial hypotension.

Design/Methods

In a retrospective review, we evaluated post-surgical outcomes for headaches and associated neurologic symptoms in 33 patients from November 2018 to October 2020 who had a positive digital subtraction myelogram for a CSF-venous fistula.

Results Of the 33 patients that underwent surgical repair for CSF-venous fistula, only two patients were lost to follow-up. Headaches were the most prominent feature which brought patients to medical attention, and 19% of patients had a persistent post-surgical headache with only 2 patients out of 31 with no improvement (p-value <0.001). Other symptoms for which surgical outcomes were observed were cognitive disturbance, tinnitus, gait disturbance, hearing abnormalities, dizziness, movement disorder, altered vision, and personality changes. Of these, 16% of patients with cognitive disturbances had this symptom post-surgically and only 2 patients experienced no improvement (p-value <0.05). Six percent of patients with gait disturbance had this symptom post-surgically and of those 100% experienced partial improvement in this symptom (p-value <0.05). All but one patient noticed a global improvement in symptoms. Adverse events were minor and included surgical site pain and extremity or dermatomal paresthesia, numbness and burning.

Conclusions Surgical repair of CSF-venous fistula resulted in significant improvements in headache and other associated symptoms. In patients with CSF-venous fistula as a cause to SIH, patients may be able to forego EBP given the excellent outcomes and minor adverse events with surgical repair.

Authors/Disclosures
Monique M. Montenegro, MD (M Health Fairview Hospital) PRESENTER	Dr. Montenegro has nothing to disclose.
Carrie Carr (Mayo Clinic - Rochester)	Carrie Carr has nothing to disclose.
Narayan R. Kissoon, MD	The institution of Dr. Kissoon has received research support from Nevro Corporation. Dr. Kissoon has received publishing royalties from a publication relating to health care.