Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series

Abstract

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx ® . Method: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18 ® . Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. Results: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On followup, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. Conclusion: We recommend that transarterial Onyx ® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.

The Use of Onyx in Different Types of Intracranial Dural Arteriovenous Fistula

“…Subsequently, other case reports and case series were published. [2][3][4][5] We started by using Onyx for the treatment of intracranial DAVFs in 2005 based on the promising preliminary results and our experience in treating this pathology. Our series included a wide spectrum of clinical presentations, DAVF subtypes, and lesion locations.…”

“…1 Recent articles have demonstrated that the endovascular technique by using Onyx has some advantages over cyanoacrylate, including the following: greater control of the embolic agent during injection, injection time, and overall high cure rates with few complications. [2][3][4][5][6] In contrast to DAVFs with direct cortical venous drainage and reflux into cortical veins, fistulas with direct drainage into the venous sinuses are often treated with a transvenous approach, particularly for lateral or cavernous sinus DAVFs. 7,8 The cavernous DAVFs rarely have favorable arterial access, but the fistulas located in the lateral sinus often have arterial pedicles amenable to selective catheterization and adequate injection of Onyx.…”

Direct transforaminal Onyx embolization of intracranial dural arteriovenous fistulas: technical note and report of five cases

“…Complete and lasting fistula obliteration can be achieved, particularly when the embolic material reaches the fistulous connection 11. Recent articles have demonstrated that the endovascular technique using Onyx has some advantages over cyanoacrylate, including greater control of the embolic agent during injection, injection time and overall high cure rates with few complications 12 – 16…”

Percutaneous transcatheter embolization with n-butyl cyanoacrylate of hepatic hemorrhagic lesions in urgent situations

“…Some authors have used Onyx to treat acute bleeding with good results (29). We feel that Onyx is indicated for situations in which long injections of material are needed to achieve better filling of the lesion, usually for intracranial (30,31) and peripheral (32) vascular malformations. With active bleeding, although Onyx can be used, we consider NBCA superior due to the ability to alter its concentration and hence the polymerization time.…”