Rapid Resolution of Cerebral Venous Sinus Thrombosis Following Transvenous Embolization of a Cerebrospinal Fluid-Venous Fistula in Spontaneous Intracranial Hypotension

Cerebral venous thrombosis (CVT) is a rare but potentially life-threatening cerebrovascular condition. Spontaneous intracranial hypotension (SIH), typically caused by cerebrospinal fluid (CSF) leaks, is a well-documented predisposing factor for CVT, occurring in approximately 1–2% of SIH cases. The optimal approach for managing SIH-related CVT remains unclear.

We report the case of a 63-year-old female who presented with extensive CVT secondary to SIH. Initial treatment of CVT included low-molecular-weight heparin anticoagulation. Diagnostic lateral decubitus digital subtraction myelography identified a right-sided CSF-venous fistula (CSFVF) at the T7-T8 spinal level as the source of SIH. The CSFVF was successfully treated with transvenous endovascular embolization using Onyx. This intervention led to the rapid resolution of both SIH and CVT, as confirmed by follow-up brain MRI performed five days post-embolization.