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Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage
  1. Daniel Mantilla1,
  2. Marine Le Corre2,
  3. Federico Cagnazzo1,
  4. Gregory Gascou1,
  5. Omer Eker3,
  6. Paolo Machi4,
  7. Carlos Riquelme1,
  8. Cyril Dargazanli1,
  9. Vincent Costalat1,
  10. Alain Bonafe1,
  11. Pierre-Henri Lefevre1
  1. 1 Service de neuroradiologie diagnostique et interventionnelle, Centre hospitalier universitaire de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
  2. 2 Service de neurochirurgie, Centre hospitalier universitaire de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
  3. 3 Service de neuroradiologie interventionnelle, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
  4. 4 Service de neuroradiologie diagnostique et interventionnelle, Hôpitaux universitaires de Genève, Genève, Switzerland
  1. Correspondence to Dr Pierre-Henri Lefevre, Department of Diagnostic and Interventional Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier 34000, France; ph.lefevre30{at}


Background and purpose Transarterial Onyx embolization is an effective treatment for patients with intracranial dural arteriovenous fistula (DAVF). A study was performed to determine whether the clinical and radiological outcomes after transarterial Onyx treatment were affected by the type of cortical venous drainage (direct vs indirect) of high-grade DAVF.

Materials and methods Between May 2006 and December 2014, demographic data, clinical presentation, angiographic characteristics, and treatment-related outcomes were collected for 54 patients divided into two groups (intracranial DAVF with direct and indirect cortical venous drainage). Continuous variables were compared with the two-tailed t test and categorical variables with the χ2 test. Statistical significance was set at P<0.05.

Results Fifty-two patients (71% with direct and 29% with indirect cortical venous drainage) underwent Onyx embolization. Immediate complete occlusion after treatment was observed in about 55% of patients without between-group difference. During the long-term follow-up, complete angiographic occlusion was achieved in 83% of patients. Specifically, 15 additional patients (40%) in the direct cortical venous drainage group progressed to complete occlusion, but only one (6%) in the indirect cortical venous drainage group. Overall, the rate of complete occlusion was higher in patients with DAVF with direct cortical venous drainage (92%) than in those with DAVF with indirect cortical venous drainage (62.5%) (P=0.01). The rate of permanent treatment-related complications was 4%, mostly related to ischemic events. Overall, 80.5% of patients had a good neurological outcome (modified Rankin Scale score 0–2).

Conclusions Transarterial Onyx embolization of intracranial high-grade DAVF is safe and effective, particularly for lesions with direct cortical venous drainage.

  • fistula
  • liquid embolic material
  • artery
  • hemorrhage

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  • Contributors DM, MLC, PHL, AB: Participated in the conception and design of the study. DM, PHL, MLC, FC, AB: Analyzed and interpreted the data. GG, OE, CR, CD, PM, VC: Collection, assembly, and possession of the raw data. CD, OE, VC, FC: Statistical expertise. DM, PHL, FC: Initial drafting of the article. PHL, FC, AB: Revision of article. DM, GG, OE, CR, CD, PM, AB: Revising the manuscript critically for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not- for-profit sectors.

  • Competing interests None declared.

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