Cranial dural arteriovenous fistula: transarterial Onyx embolization experience and technical nuances

Abstract

Transarterial Onyx embolization of cranial DAVFs, particularly using the MMA as a conduit, is a safe and effective curative therapy.

Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes

“…Multiple synchronous DAVFs may be associated with a more aggressive clinical presentation compared with solitary lesions. 19,28,32 In our cohort of patients with multiple, recurrent, de novo, or enlarging DAVFs, we observed relatively high rates of intracranial hemorrhage (26%), cranial neuropathy (47%), and other focal neurologic deficits (32%). Fistulas that eventually progressed with enlargement or de novo fistula formation were not more likely to present initially with aggressive symptoms, suggesting that neurologic symptoms at presentation cannot necessarily be extrapolated to predict a malignant clinical course.…”

“…Large series of DAVFs indicate that multiplicity is uncommon, with rates between 6.7% and 8.1%. 19,28,31,32 The frequency of de novo or enlarging progressive DAVFs is difficult to assess due to the paucity of published data. [33][34][35] In the present study, 19 (3.2%) of 579 patients had de novo or enlarging progressive fistulas, supporting the contention that such lesions are exceedingly rare.…”

Transarterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas: Long-Term Follow-Up

“…This is within the (0%-7.5%) permanent complication rate in the larger published cohorts treated with transarterial Onyx. 1,3,4,19 While the natural history of patients with benign symptoms from cDAVFs with CVD remains unclear, we think that the high success rate coupled with a low morbidity rate from transarterial Onyx embolization mandates treatment to angiographic cure once CVD is discovered, for long-term hemorrhage protection.…”

“…Immediate postembolization or short-term DSA cure rates range from 62% to 92%. [1][2][3][4] Angiographic follow-up varied per series, with a median of 3-6 months. In 2 large cohort series, the short-term DSA occlusion rate was 100%.…”

“…[1][2][3][4] We have previously reported our short-term experience using Onyx in these patients 5 and have compared the success of this technique with embolization using n-butyl cyanoacrylate. 6 However, there currently remain no published data on the longterm effectiveness for embolization of cDAVFs by using Onyx, to our knowledge.…”