Recurrent subdural hematomas in the setting of CSF-venous fistulas: illustrative case

BACKGROUND CSF leaks can cause resistant subdural hematomas (SDHs). Spinal CSF-venous fistulas (CVFs) are a rare cause of this problem. A better understanding of this phenomenon would guide decision-making when planning treatment and follow-up. The authors reviewed a case of a recurrent right-sided SDH secondary to a previously unknown CVF. In addition, a systematic review was conducted in accordance with PRISMA guidelines for previously documented cases. OBSERVATIONS Seven cases were found in the literature, with ours representing the eighth case of recurrent SDH due to a CVF-induced CSF leak. The mean age was 60 years, and 75% of patients were male. Common initial presentations included headache (100%), tinnitus (75%), and nausea/vomiting (50%). All patients were treated with Onyx embolization, with 62.5% also receiving middle meningeal artery (MMA) embolization. All patients experienced improvement of SDH size after treatment, with 62.5% demonstrating complete resolution. LESSONS Spinal CVFs are a rare but serious cause of CSF leaks and recurrent SDHs. Cases typically occur in men around 60 years of age, and common symptoms include headache, tinnitus, and nausea/vomiting. Treatment with CVF embolization results in improvement or resolution of SDH burden, while the role of MMA embolization in the treatment of these SDHs remains unclear. https://thejns.org/doi/10.3171/CASE25338