TY - JOUR T1 - Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 958 LP - 963 DO - 10.1136/neurintsurg-2017-013476 VL - 10 IS - 10 AU - Daniel Mantilla AU - Marine Le Corre AU - Federico Cagnazzo AU - Gregory Gascou AU - Omer Eker AU - Paolo Machi AU - Carlos Riquelme AU - Cyril Dargazanli AU - Vincent Costalat AU - Alain Bonafe AU - Pierre-Henri Lefevre Y1 - 2018/10/01 UR - http://jnis.bmj.com/content/10/10/958.abstract N2 - 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. ER -