Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (Onyx) arterial embolization as the primary modality: short-term results

Andrew P. CarlsonDepartments of Neurosurgery and

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Christopher L. TaylorDepartments of Neurosurgery and
Radiology, University of New Mexico, Albuquerque, New Mexico

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Howard YonasDepartments of Neurosurgery and

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Object

A dural arteriovenous fistula (DAVF) typically involves meningeal feeding arteries and can cause clinical symptoms ranging from tinnitus to rupture of draining cortical or parenchymal veins. Surgical treatment may be technically demanding. Ethylene vinyl alcohol (Onyx, ev3 Neurovascular) has several properties that make it potentially useful as a primary treatment agent for DAVF. Onyx is expected to be a permanent embolic agent. It should have a decreased risk of catheter retention when compared with other permanent embolic materials.

Methods

The authors report a series of six patients with symptomatic DAVF who were treated initially with transarterial Onyx embolization and other endovascular techniques.

Results

Five patients had complete occlusion of their DAVF noted on the follow-up angiogram obtained between 2 and 4 months. One patient had residual filling via a small arterial branch that was stable on follow-up angiography. None of the patients had worsening of neurological function. One case was complicated by a retained catheter fragment.

Conclusions

Transarterial Onyx embolization and other endovascular methods can angiographically obliterate DAVF. In some cases, embolization allowed occlusion of multiple arterial feeding arteries from a single arterial injection. Technically, the embolization was optimized when a microcatheter position immediately adjacent to the point(s) of fistulization was achieved.

Abbreviations used in this paper:

CT = computed tomography; DAVF = dural arteriovenous fistula; ECA = external carotid artery; GKS = Gamma Knife surgery; ICA = internal carotid artery; MHT = meningohypophyseal trunk; MMA = middle meningeal artery; MR = magnetic resonance; NBCA = N-butyl cyanoacrylate; SSS = superior sagittal sinus.
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