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<meta name="DC.Description" content="SUMMARY: A spinal CSF-venous fistula is an increasingly recognized type of CSF leak that causes spontaneous intracranial hypotension. The detection of these fistulas requires specialized imaging such as digital subtraction myelography or dynamic CT myelography, and several treatment options are available. A novel treatment for these CSF-venous fistulas consisting of transvenous embolization with the liquid embolic agent Onyx has been described recently, but some patients require further treatment if embolization fails. The purpose of this study was to evaluate the safety and effectiveness of surgery following transvenous embolization. In a series of 6 consecutive patients who underwent surgical ligation of the fistula after endovascular embolization, there were no surgical complications. Postoperatively, complete resolution of symptoms was reported by 5 of the 6 patients, and brain MR imaging findings of spontaneous intracranial hypotension resolved in all patients. This study suggests that surgical ligation of spontaneous spinal CSF-venous fistulas after endovascular embolization is effective and safe.

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&lt;p&gt;A spinal CSF-venous fistula is an increasingly recognized type of CSF leak that causes spontaneous intracranial hypotension. The detection of these fistulas requires specialized imaging such as digital subtraction myelography or dynamic CT myelography, and several treatment options are available. A novel treatment for these CSF-venous fistulas consisting of transvenous embolization with the liquid embolic agent Onyx has been described recently, but some patients require further treatment if embolization fails. The purpose of this study was to evaluate the safety and effectiveness of surgery following transvenous embolization. In a series of 6 consecutive patients who underwent surgical ligation of the fistula after endovascular embolization, there were no surgical complications. Postoperatively, complete resolution of symptoms was reported by 5 of the 6 patients, and brain MR imaging findings of spontaneous intracranial hypotension resolved in all patients. This study suggests that surgical ligation of spontaneous spinal CSF-venous fistulas after endovascular embolization is effective and safe.&lt;/p&gt;" />
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<meta name="twitter:title" content="Surgical Ligation of Spinal CSF-Venous Fistulas after Transvenous Embolization in Patients with Spontaneous Intracranial Hypotension" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node97874--5" data-node-nid="97874" id="top-node-97874--61447824975" data-pisa="ajnr;43/7/1073" data-pisa-master="ajnr;ajnr.A7558" data-apath="/ajnr/43/7/1073.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Surgical Ligation of Spinal CSF-Venous Fistulas after Transvenous Embolization in Patients with Spontaneous Intracranial Hypotension</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">W.I. Schievink</span>, <span class="highwire-citation-author" data-delta="1">R.B. Tache</span> and <span class="highwire-citation-author" data-delta="2">M.M. Maya</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1073-1076; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7558 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-97874--61447824975" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">W.I. Schievink </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (W.I.S., R.B.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.I.%2BSchievink%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Schievink%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.I.%2BSchievink%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5494-0688" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W.I. Schievink</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R.B. Tache </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (W.I.S., R.B.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.B.%2BTache%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tache%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.B.%2BTache%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0758-497X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.B. Tache</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.M. Maya </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Imaging (M.M.M.), Cedars-Sinai Medical Center, Los Angeles, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.M.%2BMaya%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Maya%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.M.%2BMaya%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8236-7671" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.M. Maya</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-43.7.1073.1" data-doi="10.1056/NEJMra2101561"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Schievink</span>  <span class="cit-name-given-names">WI</span></span></li></ol><cite>. <span class="cit-article-title">Spontaneous intracranial hypotension</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">385</span>:<span class="cit-fpage">2173</span>–<span class="cit-lpage">78</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1056/NEJMra2101561</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>34874632</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMra2101561&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=34874632&amp;link_type=MED&amp;atom=%2Fajnr%2F43%2F7%2F1073.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-43.7.1073.2" data-doi="10.1002/ana.26175"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Schievink</span>  <span class="cit-name-given-names">WI</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Michael</span>  <span class="cit-name-given-names">LM</span>,   <span class="cit-name-suffix">II</span>.</span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Maya</span>  <span class="cit-name-given-names">M</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Spontaneous intracranial hypotension due to skull-base CSF leak</span>. <abbr class="cit-jnl-abbrev">Ann Neurol</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">90</span>:<span class="cit-fpage">514</span>–<span class="cit-lpage">16</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1002/ana.26175</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>34291846</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/ana.26175&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=34291846&amp;link_type=MED&amp;atom=%2Fajnr%2F43%2F7%2F1073.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-43.7.1073.3" data-doi="10.1212/WNL.0000000000002986"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Schievink</span>  <span class="cit-name-given-names">WI</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Maya</span>  <span class="cit-name-given-names">MM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Jean-Pierre</span>  <span class="cit-name-given-names">S</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">A classification system of spontaneous spinal CSF leaks</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">87</span>:<span class="cit-fpage">673</span>–<span class="cit-lpage">79</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1212/WNL.0000000000002986</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>27440149</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjg6Ijg3LzcvNjczIjtzOjQ6ImF0b20iO3M6MjA6Ii9ham5yLzQzLzcvMTA3My5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-43.7.1073.4" data-doi="10.1212/WNL.0000000000000639"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Schievink</span>  <span class="cit-name-given-names">WI</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Moser</span>  <span class="cit-name-given-names">FG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Maya</span>  <span class="cit-name-given-names">MM</span></span></li></ol><cite>. <span class="cit-article-title">CSF-venous fistula in spontaneous intracranial hypotension</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">83</span>:<span class="cit-fpage">472</span>–<span class="cit-lpage">73</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1212/WNL.0000000000000639</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>24951475</span></cite></div><div class="cit-extra"><a 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<abbr class="cit-jnl-abbrev">Cephalalgia</abbr> <span class="cit-pub-date">1999</span>;<span class="cit-vol">19</span>:<span class="cit-fpage">107</span>–<span class="cit-lpage">14</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1046/j.1468-2982.1999.019002107.x</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>10214536</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1046/j.1468-2982.1999.019002107.x&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=10214536&amp;link_type=MED&amp;atom=%2Fajnr%2F43%2F7%2F1073.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a 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spontaneous intracranial hypotension: do they exist?</span> <abbr class="cit-jnl-abbrev">Neurol Clin Pract</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">11</span>:<span class="cit-fpage">e691</span>–<span class="cit-lpage">97</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1212/CPJ.0000000000001084</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>34840885</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTM6Im5ldXJjbGlucHJhY3QiO3M6NToicmVzaWQiO3M6OToiMTEvNS9lNjkxIjtzOjQ6ImF0b20iO3M6MjA6Ii9ham5yLzQzLzcvMTA3My5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 43</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jul 2022 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.I.</span> <span class="nlm-surname">Schievink</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.B.</span> <span class="nlm-surname">Tache</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.M.</span> <span class="nlm-surname">Maya</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1073-1076; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7558 </span></div>
  
  
  
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      <div class="highwire-cite-title">Surgical Ligation of CSF-Venous Fistulas Post-Embo</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.I.</span> <span class="nlm-surname">Schievink</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.B.</span> <span class="nlm-surname">Tache</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.M.</span> <span class="nlm-surname">Maya</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1073-1076; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7558 </span></div>
  
  
  
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