Clinical recurrence and rebound intracranial hypertension after transvenous embolization of cerebrospinal fluid-venous fistulas.

Abstract

Cerebrospinal fluid-venous fistula (CVF) is an increasingly recognized cause of spontaneous intracranial hypotension (SIH). We report our single-center retrospective experience with transvenous CVF embolization, focusing on clinical and imaging outcomes, recurrence, and rebound intracranial hypertension (RIH). We selected patients who underwent transvenous embolization for CVF between January 2022 and January 2026. Inclusion required a clinical diagnosis of SIH, confirmation of CVF on decubitus myelographic imaging, and completion of transvenous embolization. Brain MRI was scored using the Bern SIH score. Outcomes included immediate post-procedural response, symptom resolution at 3 months, RIH, recurrence, procedural complications, and final clinical outcome. Forty-six patients were included in the primary analysis. Brain MRI features of SIH were present in just over half of patients. Symptom resolution at 3 months was achieved in 80.4%, while overall RIH occurred in 26.1%. Among evaluable patients, recurrence occurred in 18.9%. One procedural complication occurred without lasting clinical sequelae. In patients with available post-treatment MRI, Bern score improved after embolization. Transvenous CVF embolization was associated with favorable clinical and imaging outcomes. Brain MRI status showed a consistent directional association with outcome, rebound intracranial hypertension and SIH recurrence.