Incidence and Predictors of Rebound Intracranial Hypertension after Transvenous Embolization of CSF-Venous Fistulas
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT BACKGROUND AND PURPOSE: Cerebrospinal fluid-venous fistulas (CVF) are a common cause of spontaneous intracranial hypotension (SIH) and can be treated with transvenous embolization (TVE). Rebound intracranial hypertension (RIH) is an important periprocedural consideration after TVE and CSF leak closure. The purpose of this study was to determine the incidence and severity of post-procedure RIH among patients with CVFs treated with TVE. MATERIALS AND METHODS: This investigation was a single center, retrospective cohort of consecutive patients treated with TVE for SIH due to a CVF. Patients were included who had early (1-3 days post-TVE procedure) clinical follow-up documenting presence/severity of RIH. RIH was classified as absent, mild (i.e. rated 1-4/10 in severity), moderate (i.e. rated 5-7/10), or severe (i.e. rated 8-10/10). Rate of RIH was then determined. Logistic regression analysis was used to evaluate for clinical predictors of moderate-to-severe RIH and need for eventual therapeutic lumbar puncture (LP). RESULTS: In total, 100 consecutive patients (mean age, 59.4 years old, 63% female) who underwent 105 TVE procedures for 132 CVFs were included. RIH of any severity (mild to severe) occurred in 80% of cases after TVE and was moderate-to-severe in 54% of cases. A therapeutic LP was needed for RIH in 8 cases (7.6%). On multivariate regression, TVE of a single CVF (versus >1 CVF) was independently associated with occurrence of moderate-to-severe RIH (OR: 2.8 [CI: 1.04 to 7.85], p=0.04). Furthermore, higher pre-TVE opening pressure (third tertile, 17-28 cmH2O) was associated with eventual need for therapeutic LP (OR: 5.0 [CI: 1.14 to 25.9], p=0.03). CONCLUSIONS: Early RIH is common after TVE, with symptoms occurring in 80% of all cases. Approximately half of patients will experience moderate-to-severe RIH early after TVE. These findings underscore the value of routine early follow-up after TVE and emphasize the need for proceduralists to be familiar with management strategies for RIH. ABBREVIATIONS: TVE＝ Transvenous embolization; RIH = Rebound intracranial hypertension; CVF = cerebrospinal fluid-venous fistula
DOI: 10.3174/ajnr.a9080
Authors: Derrek Schartz, Peter G. Kranz, Timothy J. Amrhein, Jay Willhite, Linda Gray, Michael D. Malinzak, Nicholas T. Befera
Institutions: Duke University, Duke Medical Center
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415967216