Purpose To evaluate the efficacy of ethanol, ethanol and coils, nBCA, and Onyx management of complex dural AVF.
Materials and methods 13 patients (mean age 39 years; 8 females, 5 males). All patients presented with dural AVF involving the transverse sinus, sigmoid sinus and cavernous sinus. One patient suffered from high output cardiac state due to the massive size of her combined dural fistula and scalp AVM. All patients underwent MR and cerebral arteriogram evaluations. Patients underwent ethanol embolization, coil embolization, ethanol and coil embolization, nBCA embolization and Onyx embolization to treat these acquired dural AVF were non-traumatic.
Results 12/13 patients were endovascularly cured of their disease at a mean follow-up of five months. One patient’s therapy is ongoing. In those patients who had thrombosed sigmoid sinuses and partially thrombosed transverse sinuses with venous drainage being cortical because of the occluded sinuses, novel approaches were utilized to reach the point of fistualization and treat with coils and ethanol. Sacrifice of the diseased transverse and sigmoid sinus was also utilized to treat the large dural AVF involving these segments. In the cavernous sinus coil embolization and nBCA embolization was utilized via surgical cut-down to access the Superior Ophthalmic Vein to navigate to the Cavernous Sinus when the Inferior Petrosal Sinus was incomplete. In those patients presenting with pulsatile tinnitus it was absent at follow-up. Headaches also resolved. Except for one patient with a transient homonymous hemianopsia, no other complication occurred.
Conclusions Complex acquired dural AVF can be treated by endovascular means. With meticulous technique complications can be avoided. Many embolic agents are successful in ablating dural AVF in all dural sinuses.
Disclosures W. Yakes: None.
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