Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas

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  • 1 Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris;
  • | 2 University of Paris;
  • | 3 Department of Experimental Neuropathology, Institut Pasteur, Paris, and French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge; and
  • | 4 INSERM UMR_S 1140, University of Paris, France
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OBJECTIVE

Intracranial dural arteriovenous fistula (DAVF) is mainly treated with an endovascular approach. Two major treatment advances include transvenous embolization (TVE) with coils in 1989 and, more recently, transarterial embolization with Onyx. The aim of this study was to present a large monocentric series of patients with DAVF treated with TVE. This series reports more than 20 years of experience and describes the evolution of the medical management of these patients, as well as current indications for this treatment at the authors’ center.

METHODS

Consecutive patients treated for intracranial DAVFs with TVE from 1995 to 2018 were included. Clinical and imaging data were systematically collected. Univariate and multivariate analyses were performed to identify factors that were significantly associated with adverse clinical course or complications.

RESULTS

In this study of 136 patients with 142 DAVFs treated with TVE, the occlusion rate was 90%. The median length of follow-up was 11 months. The rate of permanent complications was 5.1%, and the procedure-related mortality rate was 1.5%. Procedure-related mortality was associated with extension of thrombosis that was observed early in our experience. The introduction of a postoperative anticoagulation regimen has drastically decreased the occurrence of this complication. Other minor complications included cochleovestibular syndrome after embolization of lateral sinus DAVF and oculomotor nerve damage after embolization of cavernous sinus DAVF.

CONCLUSIONS

TVE allows efficient occlusion of DAVF. It remains a valid option for DAVF located on a sinus that does not participate in normal venous drainage of the brain.

ABBREVIATIONS

DAVF = dural arteriovenous fistula; DMSO = dimethyl sulfoxide; DSA = digital subtraction angiography; EoT = extension of thrombosis; EVOH = ethylene vinyl alcohol copolymer; IJV = internal jugular vein; mRS = modified Rankin Scale; TAE = transarterial embolization; TOF = time of flight; TVE = transvenous embolization.

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Contributor Notes

Correspondence Alexis Guédon: Hôpital Lariboisière, Paris, France. alexis.guedon@aphp.fr.

INCLUDE WHEN CITING Published online May 28, 2021; DOI: 10.3171/2020.10.JNS203604.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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