Two Failure Mechanisms Identified for CVF Persistence After Transvenous Embolization in Spontaneous Intracranial Hypotension

In 10 patients with local CSF-venous fistula (CVF) recurrence after transvenous embolization (TVE), two failure mechanisms emerged: Onyx cast margin leakage (external/basivertebral veins) and incomplete internal epidural venous plexus occlusion — findings that may guide technica…

• Retrospective mechanistic case series of 10 patients with symptomatic local CVF persistence/recurrence after TVE; prior literature puts the recurrence rate at ~8%.
• Two distinct mechanisms: (1) CVF at the margin of the Onyx cast, typically involving the external venous plexus or basivertebral vein; (2) inadequate occlusion of the internal epidural venous plexus, not necessarily at the distal cast margin.
• Key limitation: very small series (n=10), likely single or limited center; no control group; findings are hypothesis-generating and require prospective validation before guiding technical protocols.

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