{
  "abstract": "Objective To evaluate early and mid-term imaging and clinical outcomes following transvenous embolization of cerebrospinal fluid-venous fistulas (CSFVFs) in patients with spontaneous intracranial hypotension (SIH).Methods From November 2022 to November 2024, 60 consecutive patients with SIH and confirmed CSFVF underwent transvenous embolization using Onyx. Of these, 40 patients underwent brain MRI pre-treatment, 24 hours post-treatment, and at a 3-month follow-up. The primary outcome was regression of brain MRI abnormalities at 24 hours and 3 months. Secondary outcomes included rates of symptom improvement, predictors of clinical improvement, and complication rates.Results The mean patient age was 61 years, and 65% were female. All procedures were technically successful. The median SIH score significantly decreased from 6 pre-treatment to 3.5 at 24 hours (P=0.01) and to 2 at 3 months (P=0.004). Early improvement in SIH score correlated with clinical improvement at 24 hours (P=0.002), which was observed in 77.5% of patients. Pachymeningeal enhancement (87.5%) and venous sinus engorgement (75%) were the most common MRI abnormalities. Both findings regressed in approximately 50% of patients at 24 hours and in 80% of patients at 3 months. At 3 months, 82.5% of patients achieved complete clinical recovery. Rebound post-treatment headaches occurred in 32.5% of patients but resolved within 7 days. The morbidity rate was 0%.Conclusions Transvenous embolization of CSFVFs results in early and sustained clinical and imaging improvements in patients with SIH. These findings support the efficacy of this intervention as a primary treatment for CSFVFs.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France"
      ],
      "name": "Federico Cagnazzo"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France"
      ],
      "name": "Emmanuelle Le bars"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France"
      ],
      "name": "Gaetano Risi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Centre Montpellier, Montpellier, France"
      ],
      "name": "Nicolas Lonjon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France"
      ],
      "name": "Liesjet E H van Dokkum"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital Gui de Chauliac, Montpellier, France"
      ],
      "name": "Lucas Corti"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France",
        "Neuroradiology, CHRU Gui de Chauliac, Montpellier, France"
      ],
      "name": "Vincent Costalat"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital Gui de Chauliac, Montpellier, France"
      ],
      "name": "Anne Ducros"
    }
  ],
  "title": "Early brain MRI changes following transvenous embolization of cerebrospinal fluid-venous fistulas in spontaneous intracranial hypotension",
  "uid": "1452cd18-9a39-522c-ab81-2da7ee359c77"
}