Skip to main content Accessibility help
×
Home

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

  • Jason Chew (a1), Alain Weill (a2), François Guilbert (a2), Jean Raymond (a2), Marie-Eve Audet (a2) and Daniel Roy (a2)...

Abstract

Purpose:

To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx.

Materials & Methods:

Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months).

Results:

Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose.

Conclusion:

Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage
      Available formats
      ×

Copyright

Corresponding author

Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada

References

Hide All
1.Cognard, C, Gobin, YP, Pierot, L, Bailly, AL, Houdart, E, Casasco, A, et al.Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194(67):67180.
2.Satomi, J, van Dijk, MC, terBrugge, KG, Willinsky, RA, Wallace, MC.Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg. 2002;97:76770.
3.van Rooij, WJ, Sluzewski, M, Beute, GN.Dural arteriovenous fistulas with cortical venous drainage: incidence, clinical presentation, and treatment. AJNR Am J Neuroradiol. 2007 Apr;28(4):6515.
4.van Dijk, MC, terBrugge, KG, Willinsky, RA, Wallace, MC.Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33:12336.
5.Borden, JA, Wu, JK, Shucart, WA.A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995 Feb;82(2):16679.
6.Roy, D, Raymond, J.The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery. 1997;40:113341.
7.Pan, DH, Chung, WY, Guo, WY, Wu, HM, Liu, KD, Shiau, CY, et al.Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse sinus. J Neurosurg. 2002;96:8239.
8.Lewis, AI, Tomsick, TA, Tew, JM Jr. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg. 1994 Dec;81(6):8519.
9.Friedman, JA, Pollock, BE, Nichols, DA, Gorman, DA, Foote, RL, Stafford, SL.Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg. 2001 Jun;94(6):88691.
10.Toulgoat, F, Mounayer, C, Túlio Salles Rezende, M, Piotin, M, Spelle, L, Lazzarotti, G, et al.Embolisation par voie artérielle de malformations artérioveineuses durales intracrâniennes à l’aide d’ethylvinyl alcool copolymère (Onyx® 18). J Neuroradiol. 2006;33:10514.
11.Carlson, AP, Taylor, CL, Yonas, H.Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (Onyx) arterial embolization as the primary modality: short-term results. J Neurosurg. 2007;107:11205.
12.Arat, A, Inci, S.Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report. Neurosurgery. 2006 Jul;59(1 Suppl 1):ONSE169-70; discussion ONSE169-70.
13.Cognard, C, Januel, AC, Silva, NA Jr, Tall, P.Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008 Feb;29(2):23541.
14.Nogueira, RG, Dabus, G, Rabinov, JD, Eskey, CJ, Ogilvy, CS, Hirsch, JA, et al.Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2008 Jan;29(1):917.
15.Nelson, PK, Russell, SM, Woo, HH, Alastra, AJ, Vidovich, DV.Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg. 2003 Mar;98(3):498506.
16.Mounayer, C, Hammami, N, Piotin, M, Spelle, L, Benndorf, G, Kessler, I, et al.Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients. AJNR Am J Neuroradiol. 2007 Mar;28(3):51823.
17.Weber, W, Kis, B, Siekmann, R, Kuehne, D.Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects. AJNR Am J Neuroradiol. 2007 Feb;28(2):3717.
18.van Rooij, WJ, Sluzewski, M, Beute, GN.Brain AVM embolization with Onyx. AJNR Am J Neuroradiol. 2007 Jan;28(1):1727.

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

  • Jason Chew (a1), Alain Weill (a2), François Guilbert (a2), Jean Raymond (a2), Marie-Eve Audet (a2) and Daniel Roy (a2)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed