Background and purpose Transvenous embolization for cerebrospinal fluid–venous fistula (CVF)-related spontaneous intracranial hypotension is increasingly performed, yet procedure-level dosimetry and specific benchmarks are undefined. We quantified radiation exposure during CVF embolization, identified determinants of higher dose, and derived local reference levels using diagnostic-reference-level (DRL) methodology. Methods This retrospective study analyzed a single center cohort of consecutive CVF embolizations (May 2023–September 2025). Studied dose indices were kerma–area product (KAP, Gy·cm²) and reference air kerma (K a,r , Gy), partitioned by acquisition mode and plane. Associations with patient/procedural variables (body mass index (BMI), number of levels, navigation time, Onyx injection time, fluoroscopy time, plane use, cone-beam CT (CBCT)) were evaluated using non-parametric tests and Spearman correlations. DRLs were defined as the 75th percentile. Radiation-attributable skin effects were assessed at follow-up when indicated. Results 52 embolizations were performed in 43 patients. Median KAP was 288.3 Gy·cm² and median K a,r 3.29 Gy. For all procedures, DRLs were KAP 515.7 Gy·cm² and K a,r 4.76 Gy; for single-level cases, K a,r 3.23 Gy. K a,r >3 Gy occurred in 28/52 (53.8%) procedures. Dose accrued predominantly on the lateral plane and increased with higher BMI, more embolized levels, and longer navigation/injection times. CBCT use was not associated with higher dose. No radiation-attributable skin injury was documented on follow-up. Conclusions Transvenous CVF embolization frequently incurs significant radiation exposure, mostly driven by lateral plane utilization and procedural complexity. We propose practical adjustments—limiting lateral plane utilization, digital zoom, and staging multilevel cases—that can plausibly reduce exposure.
Orru et al. (2026) studied this question.