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

BACKGROUND AND OBJECTIVES: 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). METHODS: 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. RESULTS: 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. DISCUSSION: 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.