Tiffany's story
Spinal CSF venous fistula embolization
Emerging treatment for rare spinal condition helps Tiffany get her life back
Mayfield neurosurgeons are on the leading edge of CSF venous fistula embolization
Tiffany complained to her doctors of "brain fog." She laments the lost memories. Even when her first grandchild was born, there are details she still can't quite remember.
"It's sad, what I missed," she says. "But now, I feel like I've gotten my life back."
Tiffany's medical journey took her to a variety of specialists searching for the cause of her symptoms. She eventually was referred to Mayfield Brain & Spine, where she met neurosurgeon Dr. Michael Robinson. He determined that Tiffany was suffering from a rare condition called a spinal CSF venous fistula, an abnormal connection where cerebrospinal fluid leaks into veins surrounding the spinal cord. The spinal leak lowers the pressure around the brain, eventually causing a blood collection called a subdural hematoma.
Dr. Robinson recommended an emerging procedure to block off, or "embolize," several of these tiny veins. He and fellow neurosurgeon Dr. Soliman Oushy are helping Mayfield develop a specialty in treating rare neurovascular conditions that involve the series of tiny arteries and veins interwoven through the brain and spinal canal.
With her medical training as a nurse, Tiffany felt like she understood the technology. She also realized that the procedure Dr. Robinson recommended is still in its infancy.
"Dr. Robinson said he saw a couple of leaks that he could fix and that I would feel better," she says. "After the surgery, the change was instant. When I woke up, I was groggy, but after that I felt so much better."
Tiffany had first noticed the "severe fluctuating brain fog" several years before, after a fall while rushing through the airport. She reported severe headaches, fatigue and nausea.
MRI showing subdural fluid collections (white) on left and right sides of Tiffany's brain.
"Nothing was right," she recalls now. "Back then, it seemed like I was just a different person."
Dr. Robinson says the causes of CSF venous fistula are uncertain. But patients often report the fuzzy memory and other symptoms that Tiffany experienced.
A myelogram shows the CSF leaking into tiny veins (arrow heads).
The anatomy of a CSF venous fistula.
She had two procedures with Dr. Robinson and Dr. Oushy, both at The Jewish Hospital-Mercy Health. In about one-quarter of patients diagnosed with a spinal CSF venous fistula, additional leaks can occur and make another surgery necessary, according to Dr. Robinson.
The surgery involved snaking a catheter up through a vein in the patient's groin into the spinal column, then using a glue-like substance to embolize the veins and block the path of the spinal fluid. Treating the fistula in the spine indirectly cures the subdural hematoma in the brain, Dr. Robinson says.
"Some patients are prone to develop additional leaks," he says. "We were able to embolize the veins at several levels in the thoracic region near the middle of Tiffany's spine. This gave her immediate relief from her symptoms. We will continue to monitor her case, and she should have a strong outlook in the years to come."
Dr. Robinson said it's only been in the last decade or so that research helped neurosurgeons identify CSF venous fistula, and only the last five years since treatments have been solidified. Dr. Oushy, who joined Mayfield in 2025, trained with the Mayo Clinic team that pioneered the embolization of CSF venous fistulas.
Post-op X-ray shows glue embolization of multiple fistulas.
Advanced diagnostic imaging is critical to the success of the procedure. Dr. Robinson says the Mayfield team often works with neuro-radiologist Dr. Michael Hazenfield of the University of Cincinnati to identify and locate the CSF venous fistula, and to create that diagnostic pathway before the surgery.
Tiffany lives in Vanceburg, Ky., about 90 miles from Cincinnati. She says she couldn't find neurosurgeons in Kentucky who could perform the same procedure, so that's when she sought out care from Mayfield.
"It was worth it," she says.
~ Cliff Peale
Hope Story Disclaimer -"Tiffany's story" is about one patient's health care experience. Please bear in mind that because every patient is unique, individual patients may respond to treatment in different ways. Results are influenced by many factors and may vary from patient to patient.
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