title: Onyx migration in the endovascular management of intracranial dural arteriovenous fistulas.
abstract: Onyx migration in the endovascular treatment of dural arteriovenous fistulas (dural AVFs) is uncommon. We describe five cases of Onyx migration to the heart and draining vein and its avoidance. Between February 2007 and August 2008, Onyx migration was encountered in five patients with dural AVFs treated endovascularly at our institute. Procedures performed under general anesthesia consisted of two arterial approaches and three venous approaches. Two patients with dural AVFs involving the transverse-sigmoid sinus were treated by transarterial embolization using Onyx-18 via the occipital artery and the posterior branch of the middle meningeal artery, respectively. A piece of Onyx was found in the right ventricle on post-embolization chest X-ray film in both patients, one developed tricuspid valve dysfunction requiring thoracic surgery and one was asymptomatic. The other three patients were treated with a combination of Onyx (34 or 18) and coils transvenously with venous Onyx migration leading to draining vein occlusion, one with dural AVF involving the tentorium died from venous rupture, two patients with bilateral dural AVFs of the cavernous sinus (one with deterioration of ocular symptoms and one without symptoms). Postoperative digital subtraction angiography confirmed the elimination of dural AVF in one patient, and residual fistulae in three patients. The follow-up study ranging from two to nine months (average, 4.5 months). Three patients recovered to their full activities, while one had visual disturbance. Although Onyx has been considered a controllable embolic agent, its migration to other locations causing clinical deterioration can occur. This problem should be noted and prevented.
authors.affiliation: Xiamen First Hospital Affiliated to Fujian Medical University; Fujian, China - 13823307551@139.com.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: X
authors.initials: X
authors.lastname: Lv
authors.forename: C
authors.initials: C
authors.lastname: Jiang
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.forename: K
authors.initials: K
authors.lastname: Xu
references.citation: AJNR Am J Neuroradiol. 1998 Mar;19(3):571-6
references.pmid: 9541321
references.citation: AJNR Am J Neuroradiol. 2008 Feb;29(2):235-41
references.pmid: 17989374
references.citation: Neurosurgery. 2006 Jul;59(1 Suppl 1):ONSE169-70; discussion ONSE169-70
references.pmid: 16888563
references.citation: Neuroradiol J. 2008 Jun 3;21(3):406-14
references.pmid: 24256913
references.citation: Acta Neurochir (Wien). 2007 Nov;149(11):1103-8; discussion 1108
references.pmid: 17914598
references.citation: Neurosurgery. 2007 Nov;61(5 Suppl 2):E293-4; discussion E294
references.pmid: 18091221
references.citation: Neuroradiology. 2004 Dec;46(12):1016-21
references.pmid: 15570419
references.citation: Neurosurg Clin N Am. 1992 Jul;3(3):577-90
references.pmid: 1633481
references.citation: Neuroradiology. 2006 Feb;48(2):130-4
references.pmid: 16429281
references.citation: J Neurosurg. 2008 Dec;109(6):1083-90
references.pmid: 19035723
references.citation: Neurosurgery. 2003 Oct;53(4):836-56; discussion 856-7
references.pmid: 14519216
references.citation: J Clin Neurosci. 2002 Mar;9(2):147-55
references.pmid: 11922702
references.citation: Surg Neurol. 1996 Apr;45(4):370-5
references.pmid: 8607089
references.citation: AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1240-6
references.pmid: 12812963
references.citation: Br J Neurosurg. 2007 Aug;21(4):414-6
references.pmid: 17676466
references.citation: J Neurosurg. 2008 Mar;108(3):588-90
references.pmid: 18312107
references.citation: Surg Neurol. 2003 Jun;59(6):512-6; discussion 516-7
references.pmid: 12826359
references.citation: Neuroradiology. 2008 May;50(5):433-7
references.pmid: 18288476
references.citation: Surg Neurol. 2006 May;65(5):511-5
references.pmid: 16630920
references.citation: Interv Neuroradiol. 2008 Dec 29;14(4):415-27
references.pmid: 20557741
references.citation: Neurosurgery. 2003 Jul;53(1):222-6; discussion 226-7
references.pmid: 12823894
references.citation: Neurosurgery. 1995 Dec;37(6):1187-91; discussion 1191-2
references.pmid: 8584160
references.citation: Radiology. 1995 Mar;194(3):671-80
references.pmid: 7862961
references.citation: Neuroradiol J. 2007 Dec 31;20(6):726-9
references.pmid: 24300009
references.citation: AJNR Am J Neuroradiol. 2007 Aug;28(7):1409-14
references.pmid: 17698554
references.citation: Neurosurgery. 2007 Sep;61(3):447-57; discussion 457-9
references.pmid: 17881955