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S225: VENOUS-CEREBROSPINAL FLUID FISTULA OF THE ANTERIOR SKULL BASE: ILLUSTRATIVE CASE AND A SYSTEMATIC REVIEW
Ryan K Thorpe, MD; Bamidele O Adebayo, MBBS; Ralph Abi Hachem, MD; Amanda V Jenson, MD; Duke University

INTRODUCTION: Cerebrospinal fluid (CSF)-venous fistulas (CVF) are abnormal connections between the subarachnoid space and adjacent veins, which allows for direct egress of CSF into the venous system. This most commonly occurs in the thoracic spine, but may occur in other spinal levels, and in extremely rare cases, in the skull base. Our goal was to present a report of a pediatric patient with a skull base CVF from our institution and systematically review the literature to determine optimal management.

METHODS: A systematic review of English and non-English articles using MEDLINE, Cochrane Controlled Trials Register, PubMed, Scopus, Google Scholar, Embase was performed for original articles describing patients with CVF using PRISMA guidelines.

RESULTS: 588 articles were identified. From these, 2 articles met inclusion criteria, both of which were case reports. A case report from our institution is also included. All the involved cases were pediatric male patients, with age at diagnosis ranging from 9 to 11 years old. In 2 cases, there was communication between the CSF and cavernous sinus on cisternography, and in 1 case between the CSF and subclavian vein via the soft tissue of the neck. The presenting complaints were orthostatic headaches in all cases, and CSF rhinorrhea resulting from extravasation into the soft tissue of the nasopharynx and nasal cavity in one case. Multiple surgeries (ranging from 2 to 5) for control of the CVF were required in all cases.

CONCLUSIONS: CVF in the skull base is a rare cause of intracranial hypotension and orthostatic headaches. They are challenging to diagnose and require multiple imaging modalities to definitively diagnose. CSF diversion with ventriculoperitoneal shunting can be used in intractable cases to treat CVF if open surgery is insufficient.

 

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