Objective:

We describe the phenomenon of recurrent cerebrospinal fluid-venous fistula (CVF) at a different spinal level and report the clinical and imaging features following successful treatment of the initial CVF. 

Background:

Recurrence of CVF, also known as type III cerebrospinal fluid (CSF) leak, at a new spinal level after transvenous embolization or blood/fibrin patching has not been well described before. 

Design/Methods:

Clinical data was extracted from the electronic medical records of patients diagnosed with recurrent CVF at a different spinal level after treatment of their initial CVF at our institution.

Results:

Four patients with five recurrent CVFs were identified. Three patients were initially treated with transvenous embolization, and one with fibrin patching. Brain magnetic resonance imaging (MRI) following treatment of the initial CVF showed persistence, improvement, or complete resolution of the initial abnormal findings. Pachymeningeal enhancement and venous sinus distension were the first findings to respond to treatment.  The onset of recurrent symptoms ranged from a few days to more than one year. These symptoms were associated with worsening findings on brain MRI and increase in Bern score.  

Conclusions:

Our findings underline the significance of repeated evaluation of persistent or recurring symptoms of CSF leak after treatment of CVF. They also emphasize the need to investigate risk factors of CVF recurrence in order to advance comprehensive management of CSF leaks.