Madhavan Ajay A, Shah Vinil, Chazen J Levi, Brinjikji Waleed, Cutsforth-Gregory Jeremy K, Huynh Thien, Johnson-Tesch Ben A, Mark Ian T, Shlapak Darya P, Mamlouk Mark D
From the Division of Neuroradiology (A.A.M., W.B., B.A.J.-T., I.T.M., D.P.S., T.H.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
Department of Radiology (V.S.), University of California, San Francisco, California.
AJNR Am J Neuroradiol. 2025 Feb 3;46(2):421-425. doi: 10.3174/ajnr.A8507.
CSF-venous fistulas (CVFs) are a common and increasingly recognized type of spinal CSF leak. Most of these fistulas occur in the setting of spontaneous intracranial hypotension, though nonspontaneous cases have been described as well. In most instances, CVFs arise from the dome or neck of nerve root sleeve diverticula (also called meningeal diverticula). Venous drainage typically involves some combination of the internal epidural venous plexus and external vertebral venous plexus. Not uncommonly, venous drainage into the basivertebral venous plexus or other intraosseous veins can be seen. However, the drainage is usually a secondary finding related to normal communication between intraosseous and extraosseous veins. We have recently observed unique cases in which CVFs arise directly within the vertebral elements, resulting in primarily intraosseous drainage. It is possible that this phenomenon is secondary to prominent meningeal diverticula remodeling the adjacent vertebral elements. In this clinical report, we reviewed a multi-institutional series of CVFs exhibiting primary intraosseous drainage, with the goal of illustrating the imaging findings, treatment strategies, and outcomes of the patients. Nine cases were identified demonstrating this phenomenon. We show that intraosseous CVFs can arise in virtually any part of the vertebrae and describe how this feature affects treatment.
脑脊液 - 静脉瘘（CVF）是一种常见且越来越被认可的脊柱脑脊液漏类型。这些瘘管大多发生在自发性颅内低压的情况下，不过也有非自发性病例的描述。在大多数情况下，CVF起源于神经根袖憩室（也称为脑膜憩室）的顶部或颈部。静脉引流通常涉及硬膜外静脉丛和椎外静脉丛的某种组合。静脉引流至椎体静脉丛或其他骨内静脉并不罕见。然而，这种引流通常是与骨内静脉和骨外静脉之间正常交通相关的次要发现。我们最近观察到一些独特的病例，其中CVF直接起源于椎骨内，导致主要为骨内引流。这种现象可能是由于突出的脑膜憩室重塑相邻椎骨所致。在本临床报告中，我们回顾了一系列多机构的表现为主要骨内引流的CVF病例，目的是阐述患者的影像学表现、治疗策略和治疗结果。共确定了9例显示这种现象的病例。我们表明骨内CVF几乎可出现在椎骨的任何部位，并描述了这一特征如何影响治疗。
