LB-015 Catheter-assisted sealing technique (CAST) for spontaneous cerebrospinal fluid leaks: a novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond CSF-venous fistula

M Zanaty; C Rosinski; M Elshikh; J Kinariwala; S Yamaguchi; K Dlouhy; E Samaniego; P Jabbour; M Hayakawa; S Ortega-Guitierrez

doi:10.1136/jnis-2025-SNIS.421

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LB-015 Catheter-assisted sealing technique (CAST) for spontaneous cerebrospinal fluid leaks: a novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond CSF-venous fistula

Abstract

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LB-015 Catheter-assisted sealing technique (CAST) for spontaneous cerebrospinal fluid leaks: a novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond CSF-venous fistula

M Zanaty, C Rosinski, M Elshikh, J Kinariwala, S Yamaguchi, K Dlouhy, E Samaniego, P Jabbour, M Hayakawa and S Ortega-Guitierrez

Journal of neurointerventional surgery, Vol.17(Suppl 1), pp.A302-A304

07/01/2025

DOI: 10.1136/jnis-2025-SNIS.421

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Abstract

BackgroundSpontaneous intracranial hypotension (SIH) is a severe condition caused by cerebrospinal fluid (CSF) leaks, leading to headaches and neurological impairments. Traditional epidural blood patch (EBP) treatment is often ineffective, especially in refractory cases without a source leak identified. This study introduces and evaluates the Catheter-Assisted Sealing Technique (CAST), a novel neurointerventional approach for refractory SIH. CAST involves targeted or diffuse delivery of fibrin glue into the epidural space to repair CSF leaks.MethodsA retrospective case series of ten patients with refractory SIH underwent CAST using a fluoroscopy-guided epidural catheter approach. Clinical symptom resolution and follow-up MRI findings were assessed.ResultsNine of ten patients achieved complete headache resolution and associated symptom relief. One patient experienced significant improvement without complete relief. Follow-up MRI showed resolution of pachymeningeal enhancement in all patients. One patient required repeat procedures for recurrent symptoms. No neurological injury or spinal cord compression occurred, with the only complication being transient femoral nerve palsy due to positioning that resolved within four months.Abstract LB-015 Figure 1Abstract LB-015 Figure 2ConclusionCAST is a promising, minimally invasive alternative for refractory SIH. It enables targeted or diffuse fibrin sealant application, providing effective leak closure even in cases of occult or multifocal leaks. Early results show high success and safety, but larger cohorts and extended follow-up are needed to validate it as a standard treatment.DisclosuresM. Zanaty: None. C. Rosinski: None. M. Elshikh: None. J. Kinariwala: None. S. Yamaguchi: None. K. Dlouhy: None. E. Samaniego: None. P. Jabbour: None. M. Hayakawa: None. S. Ortega-Guitierrez: None.

Catheters

Cerebrospinal fluid

Epidural

Patients

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Title: Subtitle: LB-015 Catheter-assisted sealing technique (CAST) for spontaneous cerebrospinal fluid leaks: a novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond CSF-venous fistula
Creators: M Zanaty - University of Iowa, Neurosurgery
C Rosinski - University of Iowa
M Elshikh - University of Iowa
J Kinariwala - University of Iowa
S Yamaguchi - University of Iowa, Neurosurgery
K Dlouhy - University of Iowa, Neurosurgery
E Samaniego - University of Iowa
P Jabbour - Thomas Jefferson University
M Hayakawa - University of Iowa
S Ortega-Guitierrez - University of Iowa, Radiology
Resource Type: Abstract
Publication Details: Journal of neurointerventional surgery, Vol.17(Suppl 1), pp.A302-A304
DOI: 10.1136/jnis-2025-SNIS.421
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group LTD
Language: English
Date published: 07/01/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984848112102771

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