Endovascular treatment of intracranial dural arteriovenous fistulae using Onyx: a case series.
OBJECTIVE
An endovascular approach is often the first-line treatment of dural arteriovenous fistulae (DAVFs). Information on the use of Onyx (ev3 Neurovascular, Irvine, CA) for treating DAVFs, however, is limited. Therefore, we present our early experience, technical considerations, and complications associated with the use of Onyx for DAVF embolization.


METHODS
Twenty-eight patients with 29 DAVFs treated with Onyx embolization were included in this analysis. Hospital records, operative reports, and angiograms were reviewed and analyzed.


RESULTS
Forty Onyx procedures, including 39 transarterial and 1 transvenous approaches, were performed. Fifty-one external carotid artery branches, 8 posterior meningeal artery branches, and 3 internal carotid artery branches were used for Onyx embolization. Branches of the middle meningeal artery were embolized 32 times, and the occipital artery was embolized 15 times. Twenty-one fistulae (72%) were cured angiographically with endovascular therapy. Transarterial embolization via the middle meningeal artery cured 12 DAVFs (41%). Four complications (9.7%) were recorded, including 3 transient (7.3%) and 1 permanent neurological deficits (2.4%). Follow-up imaging, which was available for 8 fistulae with angiographic cures, showed no evidence of recurrence.


CONCLUSIONS
Transarterial Onyx embolization of external carotid artery branches, particularly the middle meningeal artery, offers a high likelihood of cure. This technique provides a safe and effective method of embolization with few side effects and complications. However, long-term follow-up is needed to establish its efficacy.
Stiefel
Michael F
MF
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Albuquerque
Felipe C
FC
Park
Min S
MS
Dashti
Shervin R
SR
McDougall
Cameron G
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage* / Q000009:adverse effects; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide