Postsurgical Recurrence of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension

Spinal CSF-venous fistulas (CVF) were described in 2014 and are now recognized as an important etiology of spontaneous intracranial hypotension (SIH) 1-3. Surgical ligation is highly effective for treating CVFs4. Given the relatively recent discovery of this entity, long-term follow up on treated cases has not been available, however, surgery has generally been considered definitive treatment. We report four cases of SIH in which CVFs have recurred or developed de novo at a different spinal level following complete surgical ligation of the primary lesion. In all cases, the new CVF was not present on any pre-surgical imaging.