Safety and postoperative outcomes following nerve root ligation and transection for patients with CSF-venous fistulas: a cohort study.

Abstract

Spontaneous intracranial hypotension (SIH) is an increasingly recognized disease entity presenting with a range of symptoms, the most common of which is orthostatic headaches. Bern scores have been validated to determine the probability of SIH on brain MRI. Spinal CSF leaks represent an important underlying etiology, with approximately 20% caused by CSF-venous fistulas (CVFs), or type III CSF leaks. Surgical ligation of CVFs is a reliable treatment option. The purpose of this study was to evaluate the outcomes of surgical ligation of CVFs and determine predictors of good outcomes. This study was a retrospective review of prospectively collected data for all consecutive patients treated with nerve root ligation at the authors' institution between October 2021 and January 2025. Patient data were analyzed regarding improvement in preoperative symptoms, postoperative outcomes, quality of life, and any complications. Twenty-six patients underwent surgery for CVFs with a median follow-up of 12 (IQR 5.5-18.5) months. Twenty-two (84.6%) of 26 patients showed improvement in preoperative symptoms, with 94% showing an improvement in the Bern score at the last follow-up evaluation. Only 1 patient developed radicular pain severe enough to require further intervention, and there were no other complications reported. At last follow-up, 83.3% of patients were able to return to work. The overall preoperative Bern score was significantly correlated with postoperative outcomes. Last, self-evaluated quality of life outcomes were significantly correlated with preoperative Bern scores. Nerve root ligation is a safe and effective treatment option, and overall Bern score and venous congestion were predictive of postoperative outcomes and quality of life.