O-039 Innovative transvenous access routes for the embolization of CSF-venous fistulae: a case series
Bibliographic record
Abstract
Introduction Cerebrospinal fluid (CSF) venous fistulae pose a significant therapeutic challenge due to their complex diagnosis and varied treatment outcomes. Traditional treatments, such as epidural blood patches and surgical ligation, have been foundational yet occasionally limited in managing this condition. Recent advancements in endovascular techniques, particularly transvenous embolization via microcatheterization, offer a promising avenue for effective treatment. This technique’s innovative application, leveraging anatomical nuances for access, can be used to target CSF-venous fistulae through the spine. We present novel roadmaps for access particularly targeting CSF-venous fistulae in the upper thoracic region and cervicothoracic junction, areas previously deemed challenging. The purpose of this study is to present a series of 8 patients treated for CSF-venous fistulae utilizing novel transvenous access routes, not previously documented in the literature, emphasizing the importance of anatomical variability in improving treatment outcomes. Methods This retrospective case series analyzes 8 patients diagnosed with CSF-venous fistulae, focusing on those located at the upper thoracic and cervicothoracic junction. Recognizing the anatomical anastomosis between the hemiazygos vein and the left renal vein as a potential access route, we explored novel endovascular pathways for embolization. The procedure involved accessing the left renal vein from the inferior vena cava (IVC), diverging from the standard approach that navigates from the superior vena cava (SVC) through the azygos system. The selection criteria, procedural details, embolization technique, and follow-up protocols are elaborated, providing a comprehensive overview of the methodology employed in addressing these fistulae. Results Of the 8 patients treated using this innovative approach, significant improvement or resolution of symptoms was observed in all cases, with no major complications reported. This success underscores the viability of accessing the left renal vein as a safer and more effective route for embolizing fistulae in the upper thoracic and cervicothoracic junction. The case series demonstrates a 100% success rate in embolization procedures utilizing these novel transvenous access routes, highlighting the potential for enhanced patient outcomes through anatomically informed strategies. Conclusions The findings from this case series suggest novel navigation in anatomically challenging regions. The use of the left renal vein for transvenous access offers an effective and safe alternative to traditional approaches in managing CSF-venous fistulae. Disclosures J. Clarke: None. R. Meyer: None. M. Anderson: None. M. Walker: None. M. Levitt: 1; C; Medtronic, Stryker. 6; C; Proprio, Stroke Diagnostics, Synchron, Hyperion Surgical, Fluid Biomed, Apertur, Metis Innovative, Aeaean Advisers, Stereotaxis, Arsenal Medical. L. Kim: 2; C; Phillips North America. 4; C; Spi Surgical. B. Ghodke: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".