From the Department of Radiology, The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, 700 Lawrence Expy, Santa Clara, CA 95051 (M.D.M., P.Y.S.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.D.M., W.P.D.); and Department of Neurosurgery, The Permanente Medical Group, Kaiser Permanente Medical Center, Redwood City, Redwood City, Calif (M.F.S.).
Radiology. 2021 May;299(2):409-418. doi: 10.1148/radiol.2021204231. Epub 2021 Mar 2.
Background Cerebrospinal fluid-venous fistulas (CVFs) are one of the less common etiologic causes of spontaneous intracranial hypotension. CVFs are most commonly treated with open surgical ligation and have reportedly not responded well to percutaneous treatments. Purpose To study treatment outcomes of CT-guided fibrin glue occlusion for CVFs. Materials and Methods Retrospective review of medical records from two institutions was performed for all patients with CVFs who underwent CT-guided percutaneous fibrin glue occlusion from March to October 2020. CVFs were assessed for resolution or persistence at posttreatment decubitus CT myelography (CTM). Pre- and posttreatment brain MRI scans were reviewed for principal signs of spontaneous intracranial hypotension. Clinical symptoms were documented before and immediately after therapy, and the current symptoms to date after fibrin glue occlusion were documented. Results CT-guided fibrin glue occlusion was performed in 13 patients (mean age, 62 years ± 14 [standard deviation]; eight women) with CVFs. Ten of 10 patients who underwent final posttreatment decubitus CTM examinations showed CVF resolution. All 13 patients showed improvement on posttreatment brain MRI scans. All 13 patients are currently asymptomatic, although three patients were asymptomatic before fibrin glue occlusion. Conclusion CT-guided fibrin glue occlusion is an effective treatment for patients with cerebrospinal fluid-venous fistulas (CVFs). Direct fibrin glue administration within the CVF may be one of the key factors for success. Further studies are needed to determine the long-term efficacy of this treatment. © RSNA, 2021.
背景 脑脊髓液-静脉瘘（CSFV）是自发性颅内低血压的较不常见病因之一。CSFV 最常通过开放式手术结扎治疗，据报道对经皮治疗反应不佳。目的 研究 CT 引导下纤维蛋白胶闭塞治疗 CSFV 的效果。材料与方法 对 2020 年 3 月至 10 月期间接受 CT 引导下经皮纤维蛋白胶闭塞治疗的所有 CSFV 患者的病历进行了回顾性研究，这些患者来自两家机构。通过治疗后卧位 CT 脊髓造影（CTM）评估 CSFV 的消退或持续情况。对治疗前后的脑 MRI 扫描进行评估，以确定自发性颅内低血压的主要征象。记录治疗前和治疗后即刻的临床症状，并记录纤维蛋白胶闭塞后的当前症状。结果 在 13 例 CSFV 患者（平均年龄 62 岁±14 岁[标准差]；8 例女性）中进行了 CT 引导下纤维蛋白胶闭塞。10 例接受最终治疗后卧位 CTM 检查的患者均显示 CSFV 消退。13 例患者的脑 MRI 扫描均有改善。13 例患者目前均无症状，但有 3 例患者在纤维蛋白胶闭塞前无症状。结论 CT 引导下纤维蛋白胶闭塞是治疗 CSFV 的有效方法。CSFV 内直接给予纤维蛋白胶可能是成功的关键因素之一。需要进一步的研究来确定这种治疗方法的长期疗效。
