title: Endoarterial management of dural arteriovenous malformations with isolated sinus using Onyx-18: technical case report.
abstract: OBJECTIVE
  Anatomic and clinical cure of dural arteriovenous malformations (DAVM) with isolated sinus is difficult to achieve by endovascular means without previous surgical exposure. We propose a new management technique using a new liquid embolic agent (ethylene-vinyl alcohol copolymer [Onyx-18]; ev3 Inc., Plymouth, MN) via an endoarterial approach that would avoid surgical craniotomy.
  
  
  BACKGROUND
  Data of three consecutive patients with a DAVM with isolated sinus treated at our department between January 2005 and June 2005 are described. Procedures performed under general anesthesia consist of an arterial approach whereby a microcatheter is navigated via a meningeal feeder to the DAVM. Onyx-18, which diffuses under aqueous conditions, is then delivered, mechanically filling the isolated sinus and ultimately treating it.
  
  
  RESULTS
  The patients included two men and one woman aged 69, 71, and 64 years, respectively. All patients were classified as Merland Type IV. Two patients presented with DAVMs involving the transverse-sigmoid sinus, and one patient presented with a DAVM involving the superior sagittal sinus with an isolated venous collector. All three fistulae were treated with transarterial embolization, using Onyx-18, through the filling of the pathological sinus via the anterior meningeal artery branch of the ophthalmic artery (DAVM at the superior sagittal sinus), and the other two patients were treated by means of the petrosquamous branch of the middle meningeal artery (DAVM at the transverse-sigmoid sinus). Postoperative digital subtraction angiography confirmed the elimination of the DAVMs in all three patients. The follow-up study ranging from 3 to 12 months (average, 7.5 mo) revealed no recurrence, and all of the patients had clinical improvement and recovered to their full activities.
  
  
  CONCLUSIONS
  DAVMs with isolated sinus and retrograde venous drainage to the cortical system are aggressive vascular lesions that can be treated by transarterial embolization using Onyx-18. This procedure allowed us to achieve an anatomic and clinical cure in the three patients consecutively treated without the need for surgical exposure of the compromised sinus.
authors: Interventional and Functional Neuroradiology Department, Hôpital de la Fondation Adolphe de Rothschild, Paris, France. cesar.lucas@uol.com.br
authors: César de Paula
authors: Cde P
authors: Lucas
authors: Charbel
authors: C
authors: Mounayer
authors: Laurent
authors: L
authors: Spelle
authors: Michel
authors: M
authors: Piotin
authors: Marco T
authors: MT
authors: Rezende
authors: Jacques
authors: J
authors: Moret
mesh_terms: D000368:Aged; D001165:Arteriovenous Malformations / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D003392:Cranial Sinuses / Q000601:surgery*; D004121:Dimethyl Sulfoxide; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls; D012189:Retrospective Studies
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide