Transvenous embolisation for spontaneous intracranial hypotension caused by a cerebrospinal fluid–venous fistula

There are uncertainties about how well this procedure works or how safe it is. But there are few options to treat spontaneous intracranial hypotension caused by a cerebrospinal fluid (CSF)–venous fistula. So, it can be done while more evidence is generated about how well the procedure works and how safe it is. This means you will have regular appointments afterwards to check how well it is working or if it has caused problems.

A CSF–venous fistula is an abnormal connection that develops between the space surrounding the spinal cord and nearby veins. The fistula allows CSF (a clear liquid that surrounds the brain and spinal cord) to leak into the veins. The loss of CSF can cause pressure in the brain to drop (spontaneous intracranial hypotension).

In this procedure, a small tube is inserted through the femoral vein (transvenous) at the top of the leg and guided to the fistula. A liquid is then injected with the aim of sealing the fistula (embolisation) to stop the CSF leak.

Is this procedure right for me?

You should be included in making decisions about your care. See our webpage on shared decision making.

Your healthcare professionals should explain the risks and benefits of this procedure and how it is done. They should discuss your options and listen carefully to your views and concerns. They should offer you more information about the procedure. Your family or carers can be involved if you want or need them to be.

You will be asked to decide whether you agree (consent) to have the procedure. Find out more about giving consent to treatment on the NHS website.

Some questions to think about

• How many appointments will I need?
• What are the possible benefits? How likely am I to get them?
• What are the risks or side effects? How likely are they?
• Will I have to stay in hospital?
• What happens if it does not work or something goes wrong?
• What happens if I do not want the procedure?
• Are other treatments available?

Information and support

The NHS website has information about NHS hospital services and referrals for specialist care.

• NICE's information on interventional procedures guidance explains what an interventional procedure is and how we assess it.
• NICE’s information on recommendations explains the types of recommendation we make.

You can also get support from your local Healthwatch.

NICE is not responsible for the quality or accuracy of any information or advice provided by these organisations.

ISBN: 978-1-4731-9332-1