PT  - JOURNAL ARTICLE
AU  - Madhavan, Ajay A.
AU  - Amrhein, Timothy J.
AU  - Kodet, Michelle L.
AU  - Lutzen, Niklas
AU  - Malinzak, Michael D.
AU  - Cutsforth-Gregory, Jeremy K.
AU  - Mark, Ian T.
AU  - Garza, Ivan
AU  - Piechowiak, Eike I.
AU  - Carlton Jones, Lalani
TI  - Multiple Synchronous CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: A Multi-Institutional Case Series
AID  - 10.3174/ajnr.A8900
DP  - 2025 Jun 26
TA  - American Journal of Neuroradiology
PG  - ajnr.A8900
4099  - http://www.ajnr.org/content/early/2025/07/03/ajnr.A8900.short
4100  - http://www.ajnr.org/content/early/2025/07/03/ajnr.A8900.full
AB  - CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Due to the more routine use of decubitus myelography and advancements in various imaging techniques, recognition of CSF-venous fistulas has increased in recent years. Most commonly, patients harbor only one fistula at the time of myelography (although additional de novo fistulas can arise after treatment). Occasionally, two synchronous CSF-venous fistulas may be seen on a single myelogram. The co-existence of more than two CSF-venous fistulas, however, is quite rare and has only been previously described in two instances. Here, we present a multi-institutional series of sixteen patients with three or more concurrently discovered CSF-venous fistulas, representing the largest cohort of such patients to date. We describe their clinical features, imaging findings, treatment approaches, and outcomes.ABBREVIATIONS: CVF = CSF-venous fistula; CB-CTM = cone beam CT myelogram; DSM = digital subtraction myelography; EID = energy integrating detector; SIH = spontaneous intracranial hypotension; PCD = photon counting detector