title: Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas Presenting with Intracranial Hemorrhage in 46 Consecutive Patients: With Emphasis on Transarterial Embolization with Onyx.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness and safety as well as the clinical and angiographic results of endovascular treatment (EVT) for patients with hemorrhagic dural arteriovenous fistulas (DAVFs).
  
  
  METHODS
  From April 2009 to November 2013, 46 consecutive patients (7 women, 39 men; mean age, 46.7 years) diagnosed with hemorrhagic intracranial DAVFs at our department were enrolled in this study. Clinical and angiographic data were reviewed and evaluated.
  
  
  RESULTS
  Two fistulas were cured by transvenous approach, and all other fistulas were embolized through transarterial route. After treatment with last embolization, a residual shunt was observed in 15 patients, including near-total obliteration of the fistula in 6 patients (13.0 %) and partial obliteration of the fistula in 9 patients (19.6 %). Seven of them underwent supplementary Gamma knife surgery. Complications occurred during or after EVT in six patients. One patient died 10 days after EVT because of complications of Onyx embolus into the posterior inferior cerebellar artery. Other complications included microcatheter entrapment in one case, trigeminocardiac reflex in one, facial nerve paresis in two, and occulomotor nerve paresis in one. The facial nerve paresis in one patient markedly improved but did not completely resolve during follow-up period. The other four patients recovered well, without symptoms at clinical follow-up. Angiographic follow-up result was obtained in 35 cases, with complete obliteration in 27 of them (77.1 %). Clinical follow-up outcomes were good, with 38 patients (82.6 %) reporting modified Rankin Scale of either 0 or 1. No patient suffered recurrent intracranial hemorrhage during follow-up.
  
  
  CONCLUSIONS
  EVT was effective and safe in the modern management of ruptured intracranial DAVFs, with complete cure in most lesions. Clinical outcomes were good despite patients presenting with intracranial hemorrhage.
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Yang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, People's Republic of China. 252694812@qq.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
mesh_terms: D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Dural arteriovenous fistula; Endovascular treatment; Intracranial hemorrhage; Onyx; Transarterial embolization