The use of Onyx in different types of intracranial dural arteriovenous fistula

Abstract

Background and purpose: Recently some series have been published about the use of Onyx for the treatment of DAFVs with satisfactory results. Our aim was to describe the treatment of different types of intracranial DAVFs with transcatheter injection of Onyx through an arterial approach.

Materials and methods: At the Department of Interventional Neuroradiology, Hospital Lariboisière Paris, between January 2005 and January 2010, we treated 44 DAVFs in 42 patients. All patients were initially treated by arterial injection of Onyx. The average patient age was 56 years (range, 27-86 years), and there were 17 women and 25 men treated.

Results: A total of 58 arterial pedicles were catheterized, with the middle meningeal artery representing the most common site (n = 38). The average time of injection was 30 minutes (range, 15-60 minutes), and the average amount of Onyx was 2.5 mL (range, 0.6-6.5 mL). Of the 20 fistulas with direct venous drainage into a dural sinus (types I and II), we achieved the preservation of the sinus in 7 patients. Of the 44 fistulas embolized, 8 required a second embolization treatment and 1 fistula required a third treatment. In 9 cases, a complementary treatment was performed via transvenous embolization with coils and/or open surgery. Early complications were observed in 6 patients: Four had nerve injury (facial palsy, n = 2, and neuralgia, n = 2), and 2 had complications related to extension of venous thrombosis postembolization. All 6 patients had partial or complete resolution of these symptoms.

Conclusions: The treatment of DAVFs by intracranial arterial injection of Onyx is safe, and, in most cases, results in the occlusion of the arterial venous shunt. In DAVFs with direct sinus drainage, sinus preservation was only possible in 7 of 20 patients (35%).

Figures

Fig 1.

A and B, Anterior and lateral external carotid artery injections in early phases show a sigmoid DAVF type III. C and D, A microcatheter compatible with Onyx was positioned in the middle meningeal artery. E, Cast of Onyx. F, Final controls by external carotid artery injection show the absence of a residual fistula.

Fig 2.

A and B, Lateral external carotid artery injection in the early phase shows a sigmoid DAVF type I. Cast of Onyx after 2 Onyx injections: the first by the middle meningeal artery (C) and the second by a branch of occipital artery (D). E and F, Final controls of the external carotid and internal carotid arteries early and late phases show the absence of a residual fistula and satisfactory sigmoid sinus preservation.

Fig 3.

A and B, Anterior and lateral external artery injections in the early phases show a sigmoid DAVF type II a. C, A microcatheter compatible with Onyx is positioned in the middle meningeal artery. D, Cast of Onyx filling the sigmoid sinus. E and F, Final controls of external carotid and internal carotid artery early and late phases show the absence of residual fistula and satisfactory sigmoid sinus exclusion.