%0 Journal Article %A Daniel Mantilla %A Marine Le Corre %A Federico Cagnazzo %A Gregory Gascou %A Omer Eker %A Paolo Machi %A Carlos Riquelme %A Cyril Dargazanli %A Vincent Costalat %A Alain Bonafe %A Pierre-Henri Lefevre %T Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage %D 2018 %R 10.1136/neurintsurg-2017-013476 %J Journal of NeuroInterventional Surgery %P 958-963 %V 10 %N 10 %X 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. %U https://jnis.bmj.com/content/neurintsurg/10/10/958.full.pdf