Onyx Embolization for Tentorial Dural Arteriovenous Fistula with Pial Arterial Supply: Case Series and Analysis of Complications.
OBJECTIVE
We describe treatment with Onyx embolization in a series of cases of tentorial dural arteriovenous fistula (DAVF) with pial arterial supply. The aim of this study was to analyze the cause of intraoperative hemorrhage and to explore therapeutic strategies.


METHODS
Retrospective review was performed of 53 consecutive patients with DAVF treated by Onyx embolization between February 2009 and December 2014. Tentorial DAVF with pial arterial supply was diagnosed in 6 patients (2 women and 4 men; mean age, 47.3 years ± 10.2), and transarterial Onyx embolization was performed in these patients. Fisher exact test was used to analyze differences of incidence of procedure-related complications.


RESULTS
Intraoperative hemorrhage occurred in 2 of 6 patients with pial arterial supply. One patient died as a result of hemorrhage, and the other patient survived after craniotomy. The incidence of complications for these 6 patients (2 of 6; 33.3%) was significantly higher (P = 0.0309) compared with patients with DAVF without pial arterial supply (1 of 47; 2.1%).


CONCLUSIONS
Pial arterial supply may be a risk factor for intraoperative hemorrhage during transarterial embolization of DAVF through dural feeders. Identification of pial feeders and early superselective occlusion of such feeders are important for safe management.
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Qi
Q
Wu
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Xiang-Sheng
XS
Zhang
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Han-Dong
HD
Wang
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Qing-Rong
QR
Zhang
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Li-Li
LL
Wen
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Chun-Hua
CH
Hang
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: zhangxsp@163.com.
Xin
X
Zhang
D000328:Adult; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology; D004121:Dimethyl Sulfoxide; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply; D011145:Polyvinyls; D016896:Treatment Outcome
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
Cerebrovascular disease; Complication; Endovascular treatment; Hemorrhage