Majeed Kashif, Hanz Samuel Z, Roytman Michelle, Chazen J Levi, Greenfield Jeffrey P
Department of Neurological Surgery Weill Cornell Medicine, New York City, New York, United States.
Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, New York City, New York, United States.
Surg Neurol Int. 2021 Oct 11;12:514. doi: 10.25259/SNI_539_2021. eCollection 2021.
CSF-venous fistulas (CVF) may cause incapacitating positional headaches resulting from spontaneous intracranial hypotension/hypovolemia (SIH). Their etiology remains unknown, although unrecognized local trauma may precipitate SIH. In addition, they are diagnostically challenging despite various imaging tools available. Here, we present CVF identification using magnetic resonance myelography (MRM) and elaborate on their surgical management techniques.
Retrospective charts of confirmed and treated CVF patients with attention to their diagnostic imaging modalities and management techniques were further reviewed.
Six cases were identified of which three are presented here. There were two females and one male patient. All had fistulas on the left side. Two were at T7-T8 while the third was at T9-T10 level. Two underwent hemilaminotomies at the T7-T8 while the third underwent a foraminotomy at T9 level to access the fistula site. All CVF were closed with a combination of an aneurysm clip and a silk tie. On follow-up, all had complete resolution of symptoms with no evidence of recurrence.
Of the various imaging modalities available, MRM is particularly sensitive in localizing CVF spinal nerve level and their laterality. In addition, the technique of aneurysm clip ligation and placement of a silk tie is curative for these lesions.
脑脊液-静脉瘘（CVF）可导致因自发性颅内低压/血容量不足（SIH）引起的使人衰弱的体位性头痛。尽管未被识别的局部创伤可能引发SIH，但其病因仍不明。此外，尽管有各种可用的成像工具，它们在诊断上仍具有挑战性。在此，我们介绍使用磁共振脊髓造影（MRM）识别CVF，并详细阐述其手术管理技术。
对确诊并接受治疗的CVF患者的回顾性病历进行进一步审查，重点关注其诊断成像方式和管理技术。
共识别出6例，这里展示其中3例。有2名女性患者和1名男性患者。所有患者的瘘均位于左侧。2例位于T7-T8，第3例位于T9-T10水平。2例在T7-T8行半椎板切除术，第3例在T9水平行椎间孔切开术以进入瘘口部位。所有CVF均通过动脉瘤夹和丝线结扎相结合的方式闭合。随访时，所有患者症状完全缓解，无复发迹象。
在各种可用的成像方式中，MRM在定位CVF的脊髓神经水平及其侧方方面特别敏感。此外，动脉瘤夹结扎和丝线结扎技术对这些病变具有治愈性。
