Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18

Clinical article

Xianli Lv M.D., Chuhan Jiang M.D., Youxiang Li M.D., and Zhongxue Wu M.D.
View More View Less
  • Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

Use of the Onyx liquid embolic system has become an option for treating dural arteriovenous fistulas (DAVFs) because of its advantageous nonadhesive and cohesive properties. However, the complication rates associated with the use of this system have not been reported. The authors present their initial experience of the risks related to transarterial embolization using this system.

Methods

Between February 2005 and February 2007, 31 patients with DAVFs were treated at Beijing Tiantan Hospital. Transarterial embolization using Onyx-18 was performed as a preoperative adjunct or as definitive therapy. The demographic characteristics, angiographic features, clinical presentation, treatment, and outcome of the patients were reviewed. Clinical follow-up status was supplemented by telephone interviews to determine Glasgow Outcome Scale scores.

Results

In 19 patients (61.3%) there was complete angiographic evidence of elimination of the shunts and resolution of the symptoms. The remaining 12 patients were treated successfully but did not attain complete embolization and had residual shunting. Adverse events occurred in 5 of 31 patients, with 3 DAVFs located at the tentorium, 1 at the inferior petrosal sinus, and 1 at the cavernous sinus. Complications included trigeminocardiac reflex in 2 patients (6.5%), hemifacial hypesthesia in 3 patients (9.7%), hemifacial palsy in 2 patients (6.5%), jaw pain in 1 patient (3.2%), posterior fossa infarction in 1 patient (3.2%), and microcatheter gluing in 1 patient (3.2%). At the last follow-up examination, all patients had returned to an independent clinical status.

Conclusions

Although a complete resolution of symptoms can be achieved with transarterial embolization using the Onyx liquid embolic system, the potential for serious complications exists with this procedure, necessitating the participation of a skilled neurointerventionalist.

Abbreviations used in this paper:

CN = cranial nerve; DAVF = dural arteriovenous fistula; ECA = external carotid artery; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; ICH = intracranial hemorrhage; MMA = middle meningeal artery; NBCA = N-butyl cyanoacrylate; PVA = polyvinyl alcohol; SCA = superior cerebellar artery; TCR = trigeminocardiac reflex; VA = vertebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Abrahams JM, , Begley LJ, , Flamm ES, , Hurst RW, & Sinson GP: Alternative management considerations for ethmoidal dural arteriovenous fistulas. Surg Neurol 58:410416, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Arat A, & Inci S: Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report. Neurosurgery 59:1 Suppl ONSE169ONSE170, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Bauer DF, , Youkilis A, , Schenck C, , Turner CR, & Thompson BG: The falcine trigeminocardiac reflex: case report and review of the literature. Surg Neurol 63:143148, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Benndorf G, , Schmidt S, , Sollmann WP, & Kroppenstedt SN: Tentorial dural arteriovenous fistula presenting with various visual symptoms related to anterior and posterior visual pathway dysfunction: case report. Neurosurgery 53:222227, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Branco G, , Takahashi A, , Ezura M, , Yoshida M, & Yoshimoto T: Dural arteriovenous shunt involving the superior petrosal sinus: presentation and treatment by transvenous embolisation via the occipital and transverse sinuses. Neuroradiology 39:67 70, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Caragine LP, , Halbach VV, , Dowd CF, , Ng PP, & Higashida RT: Parallel venous channel as the recipient pouch in transverse/sigmoid sinus dural fistulae. Neurosurgery 53:12611266, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Chong WKW, & Holt M: Endovascular therapy for intracranial dural arteriovenous fistulas. Neuroradiol J 19:537549, 2006

  • 8

    Cognard C, , Gobin YP, , Pierot L, , Bailly AL, , Houdart E, & Casasco A, et al.: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671680, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    De Jesús O, & Rosado JE: Tentorial dural arteriovenous fistula obliteration using the petrosal approach. Surg Neurol 51:164 167, 1999

  • 10

    Deasy NP, , Gholkar AR, , Cox TC, & Jeffree MA: Tentorial dural arteriovenous fistulae: endovascular treatment with transvenous coil embolisation. Neuradiology 41:308312, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Defreyne L, , Vanlangenhove P, , Vandekerckhove T, , Deschrijver I, , Sieben G, & Klaes R, et al.: Transvenous embolization of a dural arteriovenous fistula of the anterior cranial fossa: preliminary results. AJNR Am J Neuroradiol 21:761765, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Deshmukh VR, , Chang S, , Albuquerque FC, , McDougall CG, & Spetzler RF: Bilateral ethmoidal dural arteriovenous fistulae: a previous unreported entity: case report. Neurosurgery 57:E809, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Deshmukh VR, , Maughan PH, & Spetzler RF: Resolution of hemifacial spasm after surgical obliteration of a tentorial arteriovenous fistula: case report. Neurosurgery 58:E202, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Du R, , Binder DK, , Halbach V, , Fischbein N, & Barbaro NM: Trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave: case report. Neurosurgery 53:216221, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Fujita A, , Tamaki N, , Nakamura M, , Yosuo K, & Morikawa M: A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular Doppler sonography: case report. Surg Neurol 56:56 61, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Halbach VV, , Higashida RT, , Hieshima GR, , Wilson CB, , Barnwell SL, & Dowd CF: Dural arteriovenous fistulas supplied by ethmoidal arteries. Neurosurgery 26:816823, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Hanaoka M, , Satoh K, , Satomi J, , Matsubara S, , Nagahiro S, & Takimoto O, et al.: Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula. Technical note. J Neurosurg 104:974977, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Im SH, , Oh CW, & Han DH: Surgical management of an unruptured dural arteriovenous fistula of the anterior cranial fossa: natural history for 7 years. Surg Neurol 62:7275, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Irie F, , Fujimoto S, , Uda K, , Toyoda K, , Hagiwara N, & Inoue T, et al.: Primary intraventricular hemorrhage from dural arteriovenous fistula. J Neurol Sci 215:115118, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Iwamuro Y, , Nakahara I, , Higashi T, , Iwaasa M, , Watanabe Y, & Hirata E, et al.: Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report. Surg Neurol 65:511515, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. Lancet 1:480484, 1975

  • 22

    Jiang C, , Lv X, , Li Y, , Liu A, & Wu Z: Transvenous embolization of cavernous sinus dural arteriovenous fistula with Onyx-18 and platinum coils. A technical note. Neuroradiol J 20:342347, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Kajita Y, , Miyachi S, , Wakabayashi T, , Inao S, & Yoshida J: A dural arteriovenous fistula of the tentorium successfully treated by intravascular embolization. Surg Neurol 52:294298, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Kim MS, , Han DH, , Han MH, & Oh CW: Posterior fossa hemorrhage caused by dural arteriovenous fistula: case reports. Surg Neurol 59:512517, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Komotar RJ: Clinicoradiological review: bilateral ethmoidal artery dural arteriovenous fistulas. Neurosurgery 60:131136, 2007

  • 26

    Lawton MT, , Chun J, , Wilson CB, & Halbach VV: Ethmoidal dural arteriovenous fistulae: an assessment of surgical and endovascular management. Neurosurgery 45:805811, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Lefkowitz M, , Giannotta SL, , Hieshima G, , Higashida R, , Halbach V, & Dowd C, et al.: Embolization of neurosurgical lesions involving the ophthalmic artery. Neurosurgery 43:12981303, 1998

    • Search Google Scholar
    • Export Citation
  • 28

    Lucas Cde P, , Caldas JG, & Prandini MN: Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula?. Surg Neurol 66:3 Suppl S2S6, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Luo CB, , Chang FC, , Wu HM, & Chung WY: Transcranial embolization of a transverse-sigmoid sinus dural arteriovenous fistula carried out through a decompressive craniectomy. Acta Neurochir (Wien) 149:197200, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Lv X, , Li Y, , Lv M, , Liu A, , Zhang J, & Wu Z: Trigeminocardiac reflex in embolization of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol 28:17691770, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Lv XL, , Li YX, , Liu AH, , Jiang CH, & Wu ZX: Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa Onyx-18. Case report. Neuroradiol J 20:5359, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Martins C, , Yasuda A, , Campero A, , Ulm AJ, , Tanriover N, & Rhoton A Jr: Microsurgical anatomy of the dural arteries. Neurosurgery 56:2 Suppl 211251, 2005

    • Search Google Scholar
    • Export Citation
  • 33

    Matsushige T, , Nakaoka M, , Ohta K, , Yahara K, , Okamotor H, & Kurisu K: Tentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: a case report. Surg Neurol 66:519523, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Mayfrank L, , Reul J, , Huffmann B, , Bertalanffy H, , Spetzger U, & Gilsbach JM: Microsurgical interhemispheric approach to dural arteriovenous fistulas of the floor of the anterior cranial fossa. Minim Invasive Neurosurg 39:7477, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35

    Murayama V, , Viñuela F, , Ulhoa A, , Akiba Y, , Duckwiler GR, & Gobin YP, et al.: Nonadhesive liquid embolic agent for cerebral arteriovenous malformations: preliminary histopathological studies in swine rete mirabile. Neurosurgery 43:11641175, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Ng PP, , Halbach VV, , Quinn R, , Balousek P, , Caragine LP, & Dowd CF, et al.: Endovascular treatment for dural arteriovenous fistulae of the superior petrosal sinus. Neurosurgery 53:2533, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37

    Pamuk AG, , Sactci I, , Cekirge HS, & Ayporr U: A contribution to the controversy over dimethyl sulfoxide toxicity: anesthesia monitoring results in patients treated with Onyx embolization for intracranial aneurysms. Neuroradiology 47:380386, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Panneton WM, & Yavari P: A medullary dorsal horn relay for the cardiorespiratory responses evoked by stimulation of the nasal mucosa in the muskrat Ondatra zibethicus: evidence for excitatory amino acid transmission. Brain Res 691:3745, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39

    Pannu Y, , Shownkeen H, , Nockels RP, & Origitano TC: Obliteration of a tentorial dural arteriovenous fistula causing spinal cord myelopathy using the cranio-orbital zygomatic approach. Surg Neurol 62:463467, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40

    Rezende MT, , Piotin M, , Mounayer C, , Spelle L, , Abud DG, & Moret J: Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note. Neuroradiology 48:130134, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41

    Rivet DJ, , Goddard JK III, , Rich KM, & Derdeyn CP: Percutaneous transvenous embolization of a dural arteriovneous fistula through a mastoid emissary vein. Technical note. J Neurosurg 105:636639, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42

    Roy D, & Ramond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:11331144, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43

    Sasaki T, , Hoya K, , Kinone K, & Kirino T: Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations: case report. Neurosurgery 37:820825, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44

    Satoh K, , Satomi J, , Nakajima N, , Matsubara S, & Nagahiro S: Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases. J Neurosurg 94:422426, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45

    Satoh M, , Kuriyama M, , Fujiwara T, , Tokunaga K, & Sugiu K: Brain stem ischemia from intracranial dural arteriovenous fistula: case report. Surg Neurol 64:341345, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46

    Schaller B: Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas. Clin Neurol Neurosurg 107:468474, 2005

  • 47

    Schaller B: Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity?. J Neurol 251:658665, 2004

  • 48

    Schaller B, , Probster R, , Strebal S, & Gratzl O: Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 90:215220, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49

    Shah SB, , Lalwani AK, & Dowd CF: Transverse/sigmoid sinus dural arteriovenous fistulas presenting as pulsatile tinnitus. Laryngoscope 109:5458, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50

    Shin M, , Kurita H, , Tago M, & Kirino T: Stereotactic radiosurgery for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases. Neurosurgery 46:730 734, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51

    Tomak PR, , Cloft HJ, , Cawley CM, , Dion J, & Barrow DL: Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 52:750762, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52

    Troffkin NA, , Graham CB III, , Berkmen T, & Wakhloo AK: Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg 99:579583, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53

    White DV, , Sincoff EH, & Abdulrauf SI: Anterior ethmoidal artery: microsurgical anatomy and technical considerations. Neurosurgery 56:2 Suppl 406410, 2005

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1218 370 104
Full Text Views 238 18 0
PDF Downloads 179 18 0
EPUB Downloads 0 0 0