Introduction/purpose Intracranial Dural arteriovenous fistulae (DAVFs) with cortical venous drainage have a significant morbidity and mortality. Complete closure of these lesions is necessary to reduce these risks. This study retrospectively compares the outcomes of all the local endovascular embolization of DAVFs from 1998 to 2015. We propose that Onyx embolization resulted in fewer complications, similar procedure time and a higher chance of complete obliteration with no need for post-embolization surgery for the DAVF than other embolization methods.
Materials and methods 117 patients with endovascular embolization for intracranial vascular malformations from 1998 to 2015 were retrospectively reviewed. Patients with arteriovenous malformations or carotid cavernous fistulas were excluded. 27 patients had DAVFs which were treated with embolization during this time period. Inclusion criteria was patients that had DAVFs which were treated with embolization and had imaging on our archiving system. 23 patients met this criteria. Onyx cases were defined with intention to treat principle- any time Onyx was used, it was defined as Onyx case. 11 cases were treated with Onyx embolization, 9 cases were treated with nBCA (N-Butyl Cyanoacrylate) and 3 cases were treated with coils. Successful closure rates, complications and procedure time were compared between the various embolization treatment types.
Results Post embolization surgery was required for only 2 out of 11 patients treated with Onyx, 7 out of 9 patients treated with nBCA and 1 out of 3 patients treated with coils. The chances of not requiring post embolization surgery with Onyx (81.8%) was significantly higher (p = 0.008) than nBCA (22.22%). Although the complication rate with onyx (9.1%) was lower compared with that of nBCA (22.22%), it failed to reach statistical significance because of small sample size. Procedural time was not significantly different between Onyx (mean 267 mins) and nBCA (mean 288 mins) (p = 0.59). The odds ratio of a DAVF being treated with only Onyx and then requiring no follow up surgery was 15.75.
Conclusions Over a 17 year period, our institution finds Onyx superior in completely obliterating DAVFs to nBCA. It was also found to be as safe and as fast as nBCA, as DAVF embolization with nBCA needed multiple catheterizations and multiple injections.
Disclosures D. Choo: None. J. Shankar: None.
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