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Transarterial embolization with ONYX for treatment of intracranial non-cavernous dural arteriovenous fistula with or without cortical venous reflux
  1. Katrien De Keukeleire1,
  2. Peter Vanlangenhove1,
  3. Jean-Pierre Kalala Okito2,
  4. Giorgio Hallaert2,
  5. Dirk Van Roost2,
  6. Luc Defreyne1
  1. 1Department of Interventional Radiology, Ghent University Hospital, Ghent, Belgium
  2. 2Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Dr K De Keukeleire, Department of Interventional Radiology, Ghent University Hospital, De Pintelaan 185, Ghent B-9000, Belgium; katriendekeukeleire{at}hotmail.com

Abstract

Background and purpose To report our experience with transarterial ONYX embolization of intracranial non-cavernous dural arteriovenous fistulas (DAVFs) with or without cortical venous reflux.

Materials and methods Retrospective analysis of transarterial ONYX embolization in 20 patients with 21 DAVFs, presenting with intracranial hemorrhage (n=7), pulsatile bruit (n=7), vertigo (n=3), non-pulsatile bruit (n=1), headache (n=1) and epilepsy (n=1). Risk grading of DAVFs was Borden type I (n=6), type II (n=4) and type III (n=11).

Results 18 of 21 (85.7%) DAVFs were angiographically occluded immediately after embolization, with ONYX embolization only, in either one (n=12) or two sessions (n=2); with a combination of ONYX and glue or transvenous coiling in a single session (n=2) or in two sessions (n=1); or after previous transvenous coiling/glue embolization (n=1). At the 6 (4–14) month control digital subtraction angiography (DSA), available in 14 of 18 occluded DAVFs, one patient showed a small residual fistula (17/21 or 81% occluded). Mid-term DSA was not available because of early death (n=2) or patients were awaiting the examination (n=2). In three cases, treatment was incomplete. Of six Borden type I DAVFs, four were cured and two partially occluded with resolution of symptoms. In two DAVFs, neurosurgical access to the feeding artery allowed distal microcatheterization and successful embolization.

Conclusion Transarterial ONYX embolization offers an effective and safe treatment for all non-cavernous DAVFs, whether with or without cortical venous reflux.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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