Abstract
Introduction
Dural arteriovenous fistulae (DAVFs) are a potentially dangerous group of intracranial arteriovenous shunts with significant morbidity and mortality. Treatment has traditionally included transvenous and/or transarterial embolisation, which may be followed by surgical ligation. This study assesses the impact of Onyx on treatment.
Methods
Forty-nine consecutive patients referred for endovascular management of DAVFs between 1994 and 2008 were included in a retrospective, intention-to-treat analysis. DAVFs managed conservatively or purely surgically were excluded. Success rates and complications were compared between patients treated by transvenous, transarterial Onyx and transarterial non-Onyx material embolisation.
Results
Fifty-six separate DAVFs were detected in 49 patients. Embolisation of 52 DAVFs was performed or attempted. Transvenous sinus occlusion of ten type I or II DAVFs resulted in cure but was unsuccessful in a single type IV fistula and three of the four indirect carotico-cavernous fistulae treated in this way. Two type I and nine type III/IV were identified in the transarterial, non-Onyx group and three of 11 (27.3%) were cured. Amongst the six type II and 20 type III/IV DAVFs belonging to the transarterial Onyx group, cure was achieved in 17 of 26 (65.4%) rising to 72.7%, considering only those cases where the fistula could be accessed and Onyx was injected.
Conclusions
The introduction of Onyx has improved the endovascular cure rate of DAVFs, particularly types III and IV. Advances in technology have made an endovascular approach the management of choice for the majority of DAVFs requiring treatment. Low complication rates are achievable.
Similar content being viewed by others
References
Newton TH, Cronqvist S (1969) Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93(5):1071–1078
Sarma D, ter Brugge K (2003) Management of intracranial dural arteriovenous shunts in adults. Eur J Radiol 46(3):206–220
Borden JA, Wu JK, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82(2):166–179
Cognard C, Gobin YP, Pierot L et al (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with revised classification of venous drainage. Radiology 194(3):671–680
Barrow DL, Spector RH, Braun IF et al (1985) Classification and treatment of spontaneous carotid-cavernous fistulas. J Neurosurg 62:248–256
van Dijk JMC, ter Brugge KG, Willinsky RA, Wallace MC (2002) The clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 33(5):1233–1236
Duffau H, Lopes M, Janosevic V et al (1999) Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 90(1):78–84
Millar JS, Burke M (2007) The UKNG database: a simple audit tool for interventional neuroradiology. Neuroradiology 49(6):499–503
Murphy KJ, Gailloud P, Venbrux A et al (2000) Endovascular treatment of a grade IV transverse sinus dural arteriovenous fistula by sinus recanalization, angioplasty, and stent placement: technical case report. Neurosurgery 46(2):497–500
Liebig T, Henkes H, Brew S et al (2005) Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment. Neuroradiology 47(7):543–551
Troffkin NA, Graham CB, Berkmen T, Wakhloo AK (2003) Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg 99(3):579–583
Dawson RC, Joseph GJ, Owens DS et al (1998) Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR Am J Neuroradiol 19(3):571–576
Roy D, Raymond J (1997) The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40(6):1133–1141
Arat A, Cekirge S, Saatci I, Ozgen B (2004) Transvenous injection of Onyx for casting of the cavernous sinus for the treatment of a carotid-cavernous fistula. Neuroradiology 46(12):1012–1015
Suzuki S, Lee DW, Jahan R et al (2006) Transvenous treatment of spontaneous dural carotid-cavernous fistulas using a combination of detachable coils and Onyx. AJNR Am J Neuroradiol 27(6):1346–1349
Lv X, Jiang C, Li Y, Wu Z (2008) Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula. Eur J Radiol 71:356–362
Lv X, Jiang C, Li Y, Wu Z (2008) Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18. J Neurosurg 109(6):1083–1090
Nogueira RG, Dabus G, Rabinov JD et al (2008) Preliminary experience with Onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol 29(1):91–97
Cognard C, Januel AC, Silva NA, Tall P (2008) Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 29(2):235–241
Lv X, Li Y, Wu Z (2008) Endovascular treatment of anterior cranial fossa dural arteriovenous fistula. Neuroradiology 50(5):433–437
Jiang C, Lv X, Li Y, Zhang J, Wu Z (2009) Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 51(2):103–111
Gemmete JJ, Ansari SA, Gandhi DM (2009) Endovascular techniques for treatment of carotid-cavernous fistula. J Neuro-Ophthalmol 29(1):62–71
Wakhloo AK (2009) Endovascular treatment of dural carotid cavernous sinus fistulas. J Neuro-Ophthalmol 29(1):1–2
Gandhi D, Ansari SA, Cornblath WT (2009) Successful transarterial embolization of a Barrow type D dural carotid-cavernous fistula with ethylene vinyl alcohol copolymer (Onyx). J Neuro-Ophthalmol 29(1):9–12
Bhatia KD, Wang L, Parkinson RJ, Wenderoth JD (2009) Successful treatment of six cases of indirect carotid-cavernous fistula with ethylene vinyl alcohol copolymer (Onyx) transvenous embolization. J Neuro-Ophthalmol 29(1):3–8
He H, Jiang C, Wu Z, Li Y et al (2008) Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula. Chin Med J 121(17):1651–1655
White JB, Layton KF, Evans AJ et al (2007) Transorbital puncture for the treatment of cavernous sinus dural arteriovenous fistulas. AJNR Am J Neuroradiol 28(7):1415–1417
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Macdonald, J.H.M., Millar, J.S. & Barker, C.S. Endovascular treatment of cranial dural arteriovenous fistulae: a single-centre, 14-year experience and the impact of Onyx on local practise. Neuroradiology 52, 387–395 (2010). https://doi.org/10.1007/s00234-009-0620-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-009-0620-x