Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula

Mario Zanaty; Clayton Lawrence Rosinski; Mohamed Elshikh; Jay Kinariwala; Satoshi Yamaguchi; Kathleen Dlouhy; Edgar Samaniego; Pascal Jabbour; Minako Hayakawa; Santiago Ortega-Gutierrez

doi:10.1177/15910199251376452

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Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula

Journal article

Peer reviewed

Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula

Mario Zanaty, Clayton Lawrence Rosinski, Mohamed Elshikh, Jay Kinariwala, Satoshi Yamaguchi, Kathleen Dlouhy, Edgar Samaniego, Pascal Jabbour, Minako Hayakawa and Santiago Ortega-Gutierrez

Interventional neuroradiology

09/30/2025

DOI: 10.1177/15910199251376452

PMCID: PMC12484073

PMID: 41026952

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12484073/View

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Abstract

Background Spontaneous intracranial hypotension (SIH) is a severe condition caused by cerebrospinal fluid (CSF) leaks, leading to headaches and neurological impairments. Traditional epidural blood patch 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. Methods A 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. Results Nine of 10 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. Conclusion CAST is a promising, minimally invasive alternative for refractory SIH. It enables targeted or diffuse fibrin sealant application, providing a seemingly effective leak closure even in cases of occult or multifocal leaks. Early results show high success and safety rates, but larger cohorts and extended follow-up are needed to validate it as a standard treatment.

CSF leak

epidural blood patch

intracranial hypotension

Spine

Details

Title: Subtitle: Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula
Creators: Mario Zanaty - University of Iowa
Clayton Lawrence Rosinski - University of Iowa
Mohamed Elshikh - University of Iowa
Jay Kinariwala - University of Iowa
Satoshi Yamaguchi - University of Iowa
Kathleen Dlouhy - University of Iowa
Edgar Samaniego - University of Iowa
Pascal Jabbour - Thomas Jefferson University
Minako Hayakawa - University of Iowa
Santiago Ortega-Gutierrez - University of Iowa
Resource Type: Journal article
Publication Details: Interventional neuroradiology
DOI: 10.1177/15910199251376452
PMID: 41026952
PMCID: PMC12484073
NLM abbreviation: Interv Neuroradiol
ISSN: 1591-0199
eISSN: 2385-2011
Publisher: Sage
Language: English
Electronic publication date: 09/30/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984969245102771

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