Venus CSF Fistula

Overview

CVFs are abnormal connections between the spinal subarachnoid space and adjacent paraspinal veins that allow unregulated egress of CSF into the venous system. Resultant CSF depletion causes intracranial hypotension. Although this entity was first recognized very recently, it has rapidly emerged as a very common cause of underlying spinal CSF leak in SIH, particularly in the challenging population of patients with no leak seen on initial spinal imaging.

Indications

1. ⁠Suspicion of CSF leak
2. ⁠Unexplained headache or back pain
3. ⁠Radiculopathy or myelopathy
4. ⁠Spinal cord compression or cauda equina syndrome
5. ⁠Unexplained neurological deficits

pre procedure

1. Review patient's medical history and imaging studies
2. Confirm procedure details (e.g., approach, instrumentation)
3. ⁠Prepare necessary equipment and supplies
4. ⁠Ensure availability of:
5. Neurosurgical instruments

• Endovascular equipment (e.g., catheters, guidewires)
• Imaging equipment (e.g., fluoroscopy, ultrasound)
• Anesthesia equipment

Procedure

1. Laminectomy: Removal of part of the vertebra (lamina) to access the spinal cord.
2. ⁠Durotomy: Opening the dura mater (protective membrane) to expose the fistula.
3. Fistula repair: Suturing or clipping the fistula to prevent CSF leakage.
4. ⁠Dural closure: Closing the dura mater to prevent further CSF leakage.
5. Laminoplasty: Reattachment of the lamina to stabilize the spine.

Post procedure

1. ICU monitoring
2. Vital sign monitoring (e.g., heart rate, blood pressure)
3. ⁠Neurological monitoring (e.g., Glasgow Coma Scale)
4. ⁠Pain management (e.g., analgesics, epidural)
5. ⁠Fluid management (e.g., IV fluids, urine output)
6. ⁠Bed rest with head elevation (30-45 degrees)