The Use of Onyx in Different Types of Intracranial Dural Arteriovenous Fistula

• Published in: American journal of neuroradiology : AJNR 2011-12, Vol.32 (11), p.2185-2191
• Main Authors: ABUD, T. G, NGUYEN, A, SAINT-MAURICE, J. P, ABUD, D. G, BRESSON, D, CHIUMARULO, L, ENESI, E, HOUDART, E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - therapy; Dimethyl Sulfoxide - therapeutic use; Electrodiagnosis. Electric activity recording; Embolization, Therapeutic - methods; Female; Hemostatics - therapeutic use; Humans; Interventional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Polyvinyls - therapeutic use; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a2702

Recently some series have been published about the use of Onyx for the treatment of DAFVs with satisfactory results. Our aim was to describe the treatment of different types of intracranial DAVFs with transcatheter injection of Onyx through an arterial approach. At the Department of Interventional Neuroradiology, Hospital Lariboisière Paris, between January 2005 and January 2010, we treated 44 DAVFs in 42 patients. All patients were initially treated by arterial injection of Onyx. The average patient age was 56 years (range, 27-86 years), and there were 17 women and 25 men treated. A total of 58 arterial pedicles were catheterized, with the middle meningeal artery representing the most common site (n = 38). The average time of injection was 30 minutes (range, 15-60 minutes), and the average amount of Onyx was 2.5 mL (range, 0.6-6.5 mL). Of the 20 fistulas with direct venous drainage into a dural sinus (types I and II), we achieved the preservation of the sinus in 7 patients. Of the 44 fistulas embolized, 8 required a second embolization treatment and 1 fistula required a third treatment. In 9 cases, a complementary treatment was performed via transvenous embolization with coils and/or open surgery. Early complications were observed in 6 patients: Four had nerve injury (facial palsy, n = 2, and neuralgia, n = 2), and 2 had complications related to extension of venous thrombosis postembolization. All 6 patients had partial or complete resolution of these symptoms. The treatment of DAVFs by intracranial arterial injection of Onyx is safe, and, in most cases, results in the occlusion of the arterial venous shunt. In DAVFs with direct sinus drainage, sinus preservation was only possible in 7 of 20 patients (35%).