CSF venous embolisation

When is it considered?

When a CSF-venous fistula is proven on dynamic myelography, especially if symptoms continue after blood or glue patches, or when the fistula is clearly the main cause.

What does the procedure involve?

Usually a day-case under conscious sedation or general anaesthesia.

• A vein in the leg, arm, or neck is used for access.
• Catheters are guided into the azygos vein system, then into the small spinal vein that drains the fistula.
• A microcatheter is placed close to the target near the intervertebral foramen.
• The team double-checks the level and side against your imaging.
• A liquid embolic agent is injected to block the abnormal pathway by filling the small veins around the nerve root and nearby epidural veins.
• The access site is compressed by hand to stop bleeding.

What are the risks?

• Small tears in spinal veins. These are rare and often settle on their own or with more embolic.
• Serious complications are very uncommon. No deaths have been reported in published series, although risk is never zero.
• Rebound intracranial hypertension in about 1 in 10, often managed with a short course of acetazolamide.
• Tiny pulmonary emboli of the liquid agent can occur and are usually symptom-free.
• Bruising at the access site, which usually settles with pressure.
• Local pain at the treatment site, managed with simple pain relief.

Aftercare and follow-up

• A quick CT may be done straight after to confirm the position of the embolic if needed.
• Most people go home the same day after observation. Take simple pain relief if required.
• You will be told what to look for with rebound intracranial hypertension and whom to contact.

Follow up

• MRI of the brain and spine is usually arranged at about 3 months.
• A simple headache score before and after treatment helps track improvement.