Cerebrospinal fluid-venous fistula in hospitalized and critically ill patients.

BACKGROUND: Cerebrospinal fluid-venous fistulas are a treatable cause of spontaneous intracranial hypotension, but severe inpatient presentations remain poorly characterized. METHODS: We retrospectively reviewed adults hospitalized from 2022 to 2025 with myelography-confirmed cerebrospinal fluid-venous fistula related spontaneous intracranial hypotension at a quaternary referral centre. RESULTS: Fifteen patients were included. Subdural hematomas were present in 13 patients, and 4 required level-1 intensive care admission with depressed consciousness. Brain MRI showed features of spontaneous intracranial hypotension in 13 patients. Fistulas were localised by decubitus CT myelography in 13 patients and digital subtraction myelography in 2. Definitive treatment was achieved by transvenous embolization in 14 patients and high-volume multilevel epidural blood patching in 1. At 3 months, all patients improved, with complete symptom resolution in 13. No procedural complications occurred. CONCLUSION: Cerebrospinal fluid-venous fistula related spontaneous intracranial hypotension can cause severe inpatient morbidity. Early recognition and timely fistula closure are the most important aspects of treatment. Adjunct surgical treatment is necessary for timely recovery in selected cases.