Alves Filho Cesar Augusto Ferreira, Andreão Filipi Fim, Ferreira Lopes Plínio Gabriel, Ribeiro Felippe Figueiredo Torres, Braga Fausto, Almeida Filho Jose Alberto, Niemeyer Filho Paulo, Tanus Elias
Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Interv Neuroradiol. 2025 May 13:15910199251339544. doi: 10.1177/15910199251339544.
IntroductionSpontaneous cerebrospinal fluid (CSF) leaks, though rare, can cause significant neurological symptoms such as positional headaches and tinnitus, often due to thoracic spinal dural venous fistulas. This report describes a case of a dorsal spinal CSF venous fistula with symptom improvement after endovascular treatment.MethodsFollowing the CARE guidelines, key clinical data, including imaging, intervention, and follow-up outcomes, were collected. Informed consent was obtained.Case PresentationA 42-year-old female with a one-year history of positional headaches and tinnitus showed a CSF collection from D1 to D6 on imaging, with a suspected fistula at D5-D6. Conservative treatments failed, and the patient underwent endovascular embolization at D6, resulting in symptom improvement. Subsequent imaging identified a minor leak at L2, managed with follow-up. By January 2024, her headaches had resolved, and she resumed physical activities without recurrence.ConclusionThis case highlights the effectiveness of endovascular embolization for treating CSF venous fistulas, achieving significant symptom relief and returning to normal activities. Early diagnosis, imaging, and intervention are essential for managing these leaks and preventing complications, with regular follow-up critical for long-term recovery.
引言
自发性脑脊液(CSF)漏虽然罕见,但可导致显著的神经症状,如体位性头痛和耳鸣,通常是由于胸段脊髓硬脊膜静脉瘘所致。本报告描述了一例经血管内治疗后症状改善的背侧脊髓CSF静脉瘘病例。
方法
按照CARE指南,收集了包括影像学、干预措施和随访结果在内的关键临床数据。已获得知情同意。
病例介绍
一名有一年体位性头痛和耳鸣病史的42岁女性,影像学检查显示从D1至D6有脑脊液聚集,怀疑在D5 - D6处存在瘘管。保守治疗失败后,患者在D6接受了血管内栓塞治疗,症状得到改善。随后的影像学检查发现L2处有少量渗漏,通过随访进行处理。到2024年1月,她的头痛症状已消失,恢复了体力活动且未复发。
结论
本病例突出了血管内栓塞治疗CSF静脉瘘的有效性,实现了显著的症状缓解并恢复正常活动。早期诊断、影像学检查和干预对于处理这些渗漏及预防并发症至关重要,定期随访对长期康复至关重要。