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Technical video
Dural arteriovenous fistula onyx embolization through a non-visible previously embolized pedicle
  1. Marco Colasurdo1,
  2. Huanwen Chen1,2,
  3. Mihir Khunte3,
  4. Ajay Malhotra4,
  5. Dheeraj Gandhi1,5
  1. 1 Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  3. 3 Department of Radiology and Biomedical Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  4. 4 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  5. 5 Departments of Radiology, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Dheeraj Gandhi; dgandhi{at}umm.edu

Abstract

Cerebral dural arteriovenous fistulas (dAVFs) are commonly treated with endovascular embolization, either through arterial or venous routes in single or multi-staged procedures. Treatment outcomes depend on multiple factors, including the patient’s clinical status, the anatomy of the malformation, and the operator’s experience, but technical success is also highly dependent on choice of neurovascular devices and embolic agents. When transvenous routes are not feasible and the most obvious transarterial routes do not appear safe, deep knowledge of the dynamic fluid properties of liquid embolics can be a valuable asset. We present a case(video 1) in which a complex skull-base dAVF was completely occluded through a non-visualized previously partially embolized arterial feeder. It is a unique case in which the embolization takes advantage of the peculiar fluid dynamic properties of non-adhesive embolic agents (Onyx-Medtronic, Minnesota, USA) 18 and 34.1–3

Video 1  Technical video presenting a dAVF completely cured through a non-visible previously embolized arterial pedicle.
  • Vascular Malformation
  • Liquid Embolic Material
  • Arteriovenous Malformation
  • Fistula
  • Technique

https://doi.org/10.1136/jnis-2023-020506

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    Footnotes

    • X @AjayMalhotraRad

    • Contributors MC and DG conceived the idea. MC and HC drafted the manuscript and the illustrations. HC, MK, AM and DG revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DG reports grants from Microvention, the focused Ultrasound Foundation, the NIH and University Calgary/NoNo Therapeutics.

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