Rates of Retreatment after Transvenous Embolization of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension

BACKGROUND AND PURPOSE: Cerebrospinal fluid-venous fistulas (CVF) cause spontaneous intracranial hypotension (SIH) and can be treated with transvenous embolization (TVE). Although TVE has been shown to result in substantial symptomatic improvement, some patients may require retreatment. The purpose of this study was to clarify the rate, anatomical location, and timing of CVF recurrence/retreatment after TVE. MATERIALS AND METHODS: Single center, retrospective cohort of consecutive patients with CVF who were treated with TVE. The rate of retreatment after TVE was determined. In addition, timing of symptom onset and location of recurrent CVF was recorded. RESULTS: One hundred consecutive patients (65% female, mean age 59.3 years) with 105 CVFs treated with TVE were included. Overall, 23% (23/100) of patients required retreatment due to persistence or recurrence of symptoms. Most retreatment patients (74%, 17/23) had persistent or recurrent symptoms within 3 months after TVE. Approximately one third of patients needing retreatment (35%, 8/23) had a CVF at the same site and level as the initial CVF after having been embolized. Approximately one third (30%, 7/23) had a recurrent CVF adjacent to the initial CVF (defined as one level above, one level below, or at the same level but on the contralateral side). The remaining patients (35%, 8/23) had a CVF remote from the original fistula site. CONCLUSIONS: CVFs remote from the initial treatment site. These findings can be used to counsel patients and to manage treatment expectations.