title: Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18.
abstract: OBJECTIVE
  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.
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Xianli
authors.initials: X
authors.lastname: Lv
authors.forename: Chuhan
authors.initials: C
authors.lastname: Jiang
authors.forename: Youxiang
authors.initials: Y
authors.lastname: Li
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D004121:Dimethyl Sulfoxide / Q000009:adverse effects* / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D007407:Interviews as Topic; D007568:Jaw / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010243:Paralysis / Q000209:etiology; D011145:Polyvinyls / Q000009:adverse effects* / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide