Intrathecal fluorescein guidance in the treatment of intracranial hypotension due to spinal CSF-venous fistula

Among the causes of spontaneous intracranial hypotension (SIH), cerebrospinal fluid (CSF)-venous fistulas (CVFs) represent a recently discovered and poorly understood aetiology, for which invasive treatment (surgery vs endovascular treatment) may be required. However, CVFs are not always immediately identified during surgery. We describe a case of a woman with a 2-year history of SIH who was found to harbour a T8 CVF. The diagnostic work-out is depicted; during the surgical procedure, intrathecal fluorescein was deployed to correctly identify and ligate the CVF. The use of intrathecal fluorescein may represent an additional useful tool to make surgery for CVFs more effective and safer.