Safety and Efficacy of Intracystic Fibrin Glue Injection for CSF-Venous Fistulas

We evaluated the safety and efficacy of CT-guided intracystic fibrin glue injection for CSF-venous fistulas (CVFs) causing spontaneous intracranial hypotension. In this 2-center retrospective series, 16 patients underwent fibrin injection directly into the diverticular cyst, with additional epidural or paravertebral injection as needed. Median intracystic fibrin volume was 1.0 mL; thecal sac extension was present in 44% of cases. No serious or permanent complications, arachnoiditis, or neurologic deficits were observed. Transient rebound intracranial hypertension occurred in 31% and transient radicular pain in 6%, both resolving spontaneously. Clinical outcomes were favorable, with 88% of patients reporting complete and 12% partial symptom improvement. The median Bern score decreased from 6.0 pretreatment to 0 posttreatment, and CT myelography in a subset confirmed fistula closure. CT-guided intracystic fibrin glue injection appears to be a safe, effective, and targeted option for CVF treatment, meriting further prospective evaluation.