title: Arterial Onyx embolisation of intracranial DAVFs with cortical venous drainage.
abstract: OBJECTIVE
  To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx.
  
  
  METHODS
  Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months).
  
  
  RESULTS
  Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose.
  
  
  CONCLUSIONS
  Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern.
authors.affiliation: Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Chew
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.forename: François
authors.initials: F
authors.lastname: Guilbert
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Audet
authors.forename: Daniel
authors.initials: D
authors.lastname: Roy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011145:Polyvinyls / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer