Transvenous embolization of CSF-venous fistula

Presented at LINNC Paris 2026 by Pr. Jan Gralla and team, this live case demonstrates the endovascular management of spontaneous intracranial hypotension (SIH).

Clinical Presentation & Strategic Decision-Making

The session features a female patient in her late 50s presenting with dizziness and rushing tinnitus that severely worsened during heavy lifting, physical exertion, and Valsalva maneuvers. To treat this underlying spinal CSF-venous fistula without resorting to open surgery, the team ventures off the beaten track with a targeted transvenous approach.

Key technical highlights

Access & navigation: Establishing transfemoral venous access with a 7-Fr sheath, then navigating the azygos vein using a 7-Fr guide catheter to reach the target segmental vein.
The material setup: Securing optimal microcatheter stability and reflux control inside the target vein using a specialized RIST / 5-Fr Bernstein / Headway Duo microcatheter combination.
Embolization: Executing a venous pressure cooker technique to safely deliver Onyx 12 liquid embolic and permanently seal the fistula.

CSF venous fistula

Clinical Presentation & Strategic Decision-Making

Key technical highlights

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