Evolution of endovascular management of intracranial dural arteriovenous fistulas: single center experience.
OBJECTIVE
We aim to focus on the treatment of intracranial dural arteriovenous fistulas (DAVF) with emphasis on the evolution of endovascular management at our center over the last 13 years. We also aim to highlight the present treatment strategy, considering all the embolic agents available with us.


METHODS
This is a retrospective study of 99 patients of DAVFs treated from December 1995 to March 2009.


METHODS
Seven patients were found to have spontaneous thrombosis when taken up for treatment. The other 92 patients underwent endovascular treatment through transarterial or transvenous routes using polyvinyl alcohol particles, glue, detachable platinum coils or injection onyx as embolic agents. The treatment strategies have evolved over a period of time with changing philosophies and availability of different embolic agents.


RESULTS
Transverse- sigmoid and cavernous sinuses were the commonest sites of DAVFs. Intracranial hemorrhage was common presentation. Transarterial PVA embolization was performed in four patients, transarterial glue in 15, transvenous embolization in 33 and transarterial Onyx in 36. Direct puncture and packing of the sinuses was done in four patients. Cure was achieved in 80 out of 92 patients (cure rate of 87%). Patients who had Onyx embolization had cure rate of 92% (33 out of 36 patients). 14 complications were seen of which two were in the Onyx group.


CONCLUSIONS
Embolization of DAVFs has evolved over the last decade and has become the treatment of choice with high cure rates and improved safety. We propose the use of Onyx as the embolic agent of choice in the treatment of DAVFs.
Department of Radiology, Division of Interventional Neuroradiology, KEM Hospital, Mumbai, India.
Rashmi
R
Saraf
Manish
M
Shrivastava
W
W
Siddhartha
Uday
U
Limaye
D000792:Angiography / Q000379:methods; D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide