Fermo, Olga

Cerebrospinal fluid (CSF)–venous fistulas are an increasingly recognized source of spontaneous intracranial hypotension, for which endovascular embolization has emerged as an effective treatment option.1–3 Advances in diagnostic imaging have improved detection of CSF–venous fistulas throughout the cervical, thoracic, and lumbar spine; however, identification of lesions at the cranial and caudal extremes of the spine remains challenging.4 In video 1, we present the novel case of an anterior condylar confluence CSF–venous fistula arising from a hypoglossal canal nerve root sleeve diverticulum. We demonstrate the diagnostic evaluation, preprocedural planning, and transvenous embolization of the fistula using the pressure cooker technique, highlighting key technical considerations for navigating this uncommon venous anatomy. Finally, we review the patient’s postprocedural course and imaging findings demonstrating radiographic resolution of spontaneous intracranial hypotension. Video 1 Endovascular embolization of a cerebrospinal fluid–venous fistula arising from a hypoglossal canal nerve root sleeve diverticulum using a transvenous pressure cooker technique.