Hsieh Chia-Jung, Kuo Lu-Ting, Lai Dar-Ming, Huang Abel Po-Hao
J Neurosurg Case Lessons. 2022 Apr 11;3(15). doi: 10.3171/CASE2211.
Cerebrospinal fluid (CSF) venous fistulas are a recently discovered and underdiagnosed cause of spontaneous spinal CSF leak, which may lead to spontaneous intracranial hypotension. Most cases occur in the thoracic spine, and only 2 cases were reported in the cervical spine. Treatments include the epidural blood patch, fibrin glue injection, and surgical ligation of the fistula.
The authors report the treatment of a C6-7 CSF venous fistula, for which direct ligation was not feasible, with suboccipital decompression, leading to the complete resolution of the symptoms. Based on the clinical course and outcome in our patient, the authors summarize the previous theory and propose a hypothesis for the pathophysiology of headache and other symptoms in patients with CSF venous fistulas.
The symptoms of CSF venous fistulas may be linked not only to intracranial hypotension but also to the altered CSF dynamics induced by tonsillar herniation. Suboccipital decompression should be considered as a potential treatment option, especially in patients with Valsalva-induced headache who show a poor response to surgical ligation, patients in whom surgical ligation is not feasible, and patients with foramen magnum obstruction. Further investigation of the pathophysiology of CSF venous fistulas is warranted and should be performed in the future.
脑脊液静脉瘘是一种最近才被发现且诊断不足的自发性脊髓脑脊液漏的病因，可能导致自发性颅内低压。大多数病例发生在胸椎，颈椎仅有2例报道。治疗方法包括硬膜外血贴、纤维蛋白胶注射和瘘管手术结扎。
作者报告了一例C6 - 7脑脊液静脉瘘的治疗情况，该病例无法进行直接结扎，采用枕下减压治疗后症状完全缓解。基于我们患者的临床病程和结果，作者总结了先前的理论，并提出了脑脊液静脉瘘患者头痛及其他症状病理生理学的假说。
脑脊液静脉瘘的症状可能不仅与颅内低压有关，还与扁桃体疝引起的脑脊液动力学改变有关。枕下减压应被视为一种潜在的治疗选择，特别是对于瓦尔萨尔瓦动作诱发头痛且手术结扎反应不佳的患者、无法进行手术结扎的患者以及枕骨大孔梗阻的患者。有必要对脑脊液静脉瘘的病理生理学进行进一步研究，未来应该开展相关研究。
