Resolution of spontaneous intracranial hypotension due to a spinal CSF-venous fistula after a dynamic myelogram: illustrative case.

BACKGROUND: CSF-venous fistulas (CVFs) are abnormal connections between the spinal subarachnoid space and the adjacent venous plexus. They are typically treated by surgical disconnection, transvenous embolization, or percutaneous therapies such as epidural fibrin glue injection or blood patches that are known to be less effective for full resolution.

OBSERVATIONS: Here, the authors report a case of intracranial hypotension due to a spinal CVF that spontaneously resolved after a diagnostic spinal myelogram in the right lateral decubitus position. One hypothesis for this unique observation is the high viscosity of the contrast agent used.

LESSONS: CVFs can potentially resolve spontaneously after high-volume CSF drainage during a diagnostic spinal myelogram due to the high viscosity of contrast material in addition to a decrease in transfistula gradient. https://thejns.org/doi/10.3171/CASE25194.