Interventional procedure overview of Transvenous embolisation for spontaneous intracranial hypotension caused by a cerebrospinal fluid-venous fistula
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Appendix B: Other relevant studies
Other potentially relevant studies that were not included in the main evidence summary (tables 2 and 3) are listed in table 5 below.
Table 5 additional studies identifiedStudy | Number of people and follow up | Direction of conclusions | Reason study was not included in main evidence summary |
|---|---|---|---|
Orscelik, A., Senol, Y.C. et al. (2024) Endovascular embolization of cerebrospinal fluid-venous fistula: a comprehensive systematic review on its efficacy and safety for the management of spontaneous intracranial hypotension. Neurosurgical Review, 47(1), p.28 | Systematic review N=9 studies, 77 people | Suggests endovascular embolisation is a safe and effective treatment; larger prospective studies are needed to validate initial findings | Deprioritised due to availability of a systematic review and meta-analysis with a larger sample size. 4 out of 5 included studies had sample size less than 5. |
Orscelik A, Cutsforth-Gregory JK et al. (2024) Endovascular embolization techniques for cerebrospinal fluid-venous fistula in the treatment of spontaneous intracranial hypotension. Radiologic Clinics,62(2):345-54. | Review N=7 studies | Suggests the treatment to be effective with low complication rates but requires careful patient selection and multidisciplinary collaboration between health professionals for successful management of CVFs; prospective and multicenter studies required to confirm its safety and efficacy. | Deprioritised due to the availability of a systematic review and meta-analysis with a larger sample size. |
Houk JL, Dennison JV et al. (2022) Spontaneous intracranial hypotension: a review of pathogenesis, presentation, diagnosis, and treatment. Advances in Clinical Radiology, 4(1): 231-41. | Narrative review | Suggests comprehensive understanding of the pathophysiology of SIH and imaging characteristics for accurate diagnosis and precise localisation of underlying spinal pathology. | Deprioritised due to review presented overview of SIH and available treatment including transvenous embolisation. |
Brinjikji W, Savastano LE et al (2021) A novel endovascular therapy for CSF hypotension secondary to CSF-venous fistulas. American Journal of Neuroradiology, 42(5):882-7. | Case series N=5 people Follow-up = 3 months | 3 had complete resolution of SIH related symptoms. One had persistent tinnitus. | Deprioritised due to the study having small sample size and availability of new evidence from same centre with a larger sample which is included in main evidence summary. |
Brinjikji W, Garza I et al. (2022) Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization. Journal of neurointerventional,14(10):953-6. | Retrospective studies N=40 people Follow-up: 3 months | Transvenous embolisation resulted in clinical and radiographic improvement in 90% with no permanent complication; further studies required to validate the technique and assess long term durability of the treatment. | Deprioritised due to availability of new evidence from same centre with a larger sample which is included in main evidence summary. |
Ellens NR, Schartz D et al (2023) Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: case-series. Interventional Neuroradiology,15910199231221449. | Case series N=6 people Follow up=3 months | 3 out of 6 people had complete resolution of symptoms; further studies required to assess long term durability of the treatment. | Deprioritised due to small sample size. |
Jesse CM, Schär RT, Petutschnigg T, et al (2024) Improvement of health-related quality of life after closure of spinal CSF leaks in patient with spontaneous intracranial hypotension. Journal of Neurosurgery: Spine, 41(3):452-8. | Prospective cohort study N=21 people Follow up=3 months | Transvenous embolisation or microsurgery can enhance health-related quality of life (HRQOL), patients' subjective health perception, and headache severity. Top of Form Bottom of Form | Deprioritised due to the study including only 6 people who were managed by transvenous embolisation, the evidence presented in the study does not distinguish which outcomes are attributed to microsurgery and which are the result of embolisation. |
Noufal M, Liang CW et al (2022) Transvenous embolization for cerebrospinal fluid-venous fistula. A case series from a single community-academic center. World Neurosurgery, 168:e613-20. | Case series N=5 people Follow-up= 8 months | Transvenous embolisation seems safe and effective in short term; RCT would would help standardise care and evaluate long-term outcomes for CSF-venous fistula | Deprioritised due to small sample size. |
McRae-Posani B, Kim A et al (2025). Spinal CSF Leaks in Spontaneous Intracranial Hypotension: A Single-Institution Analysis of Incidence, Typology and Treatment Outcomes. Clinical Neurology and Neurosurgery, 108978. | Retrospective N=32 people | Targeted endovascular or surgical approaches are more likely to provide definitive treatment than epidural blood patches. | People treated with epidural blood patches as first line of treatment) and 10 people with treatment failure had transvenous embolisation. |
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