title: Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience.
abstract: OBJECTIVE
  Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach.
  
  
  METHODS
  Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images.
  
  
  RESULTS
  All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients.
  
  
  CONCLUSIONS
  Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Jae-Sang
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Seok-Mann
authors.initials: SM
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Hyuk-Jin
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Jai-Joon
authors.initials: JJ
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Hack-Gun
authors.initials: HG
authors.lastname: Bae
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Kyeong-Seok
authors.initials: KS
authors.lastname: Lee
keywords: Dural arteriovenous fistulas; Embolization; Endovascualr; Onyx; Transarterial