Epidural Onyx Treatment for Spontaneous Intracranial Hypotension Caused by a Ventral Dural Tear

Definitive treatment of spontaneous intracranial hypotension caused by a spinal CSF leak may be challenging with conservative management or an epidural blood patch. This study describes 2 cases of spontaneous intracranial hypotension treated with fluoroscopically-guided, catheter-delivered Onyx to seal a spinal CSF leak, with significant improvement observed during a 2-year follow-up. Digital subtraction myelography was used to localize the site of the CSF leak. Onyx was precisely delivered to the site of the CSF leak via a catheter under fluoroscopic guidance. Postprocedural spinal CT confirmed the presence of Onyx at the injected site. Both patients exhibited resolution of symptoms and CSF leaks during the 2-year follow-up. Repeat spinal MRI demonstrated a gradual and marked reduction in the spinal longitudinal epidural collection during the follow-up period. No noticeable complications were reported. These findings indicate that epidural Onyx treatment may represent a novel and promising strategy for managing spontaneous intracranial hypotension caused by a dural tear.