Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2010; 20(01): 26-33
DOI: 10.4103/0971-3026.59748
Interventional Radiology

Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes

Rashmi Saraf
Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, India
,
Manish Shrivastava
Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, India
,
Nishant Kumar
Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, India
,
Uday Limaye
Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, India
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs) and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula) was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%). Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.

Keywords

Dural arteriovenous fi stula - embolization - ONYX - technique


Publication History

Article published online:
02 August 2021

© 2010. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Houser OW, Campbell JK, Campbell RJ, Sundt TM Jr. Arteriovenous malformation affecting the transverse dural venous sinus-An acquired lesion. Mayo Clin Proc 1979;54:651-61.
  • 2 Nishijima M, Takaku A, Endo S, Kuwayama N, Koizumi F, Sato H, et al. Etiological evaluation of dural arteriovenous malformation of the lateral and sigmoid sinuses based on the histopathological examinations. J Neurosurg 1992;76:600-6.
  • 3 van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. The clinical course of Cranial Dural AV Fistula with long term persistent Cortical Venous reflux. Stroke 2002;33:1233-6.
  • 4 vanRooij WJ, Sluzewski M, Beute GN. Dural Arteriovenous Fistula with cortical venous drainage: Incidence, Clinical Presentation and treatment. AJNR 2007;28:651-5.
  • 5 TerBrugge K, Dural AV. Clinical presentation, Classification and Angiographic Evaluation. Interventional Neuroradiol 2003;9:99-100.
  • 6 Davies MA, Terbrugge K, Willinsky R, Coyne T, Selch J, Wallace MC. The validity of classification for the clinical presentation of Intracranial Dural arteriovenous fistula. J Neurosurg 1996;85:830-7.
  • 7 Tabrizi P, Spelzler RF, McDougall C, Albuquerque FC. Cerebral Dural Arterio-venous fistula. Interventional Neuroradiol 2003;9:101-2.
  • 8 Cognard C, Gobin YP, Piarot L, Bailly AC, Howdart E. Cerebral dural Arterio-venous fistula: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671-80.
  • 9 Lasjunias P, Chiu M, Brugge KT, Tolia A, Hurth M, Berenstein M. Neurological manifestations of intracranial dural arterio-venous malformation. J Neurosurg 1986;4:724-30.
  • 10 Awad IA, Little JR. Intracranial dural Arterio-venous malformations factors predisposing to an aggressive neurological course. J Neurosurg 1990;72:839-50.
  • 11 Koebbe CJ, Singhal D, Sheehan J, Flickinger JC, Horowitz M, Kondziolka D, et al. Radiosurgery of dural arteriovenous fistula. Surg Neurol 2005;64:392-9.
  • 12 Kiyosue H, Hori Y, Okahara M. Treatment of intracranial Dural arteriovenous Fistula: Current Strategies based on location and hemodynamics and alternative techniques of transcatheter embolization. Radiographics 2004;24:1637-51.
  • 13 Barnwell SL, Halbach VV, Higashida RT, Hieshima G, Wilson CB. Complex dural arteriovenous fistula. Results of combined Endovascular and Neurosurgical treatment in 16 patients. J Neurosurg 1989;71:352-8.
  • 14 Giller CA, Barnett DW, Thacker IC, Hise JH, Berger BD. Multidisciplinary treatment of a large cerebral dural arteriovenous fistula using embolization, surgery and radiosurgery. Proc (Bay Univ Med Cent) 2008;21:255-7.
  • 15 Sundt TM Jr, Piepgras DG. The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 1983;59:32-9.
  • 16 Koebbe CJ, Singhal D, Sheehan J, Flickinger JC, Horowitz M, Kondziolka D, et al. Radiosurgery of dural arteriovenous fistulas. Surg Neurol 2005;64:392-9.
  • 17 Mullan S, Johnson DL. Combined sagittal and lateral sinus dural fistulae occlusion. J Neurosurgery 1995;82:159-65.
  • 18 Halbach VV, Higashiba RT, Hieshima GB, Mehtinger CM, Hardin CW. Transvenous embolization of dural fistula involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 1989;10:385-92.
  • 19 Siekman R, Weber W, Kis B, Kuhne D. Transverse treatment of a Dural arterio-venous fistula of the transverse sinus by embolization with Platinum coils and ONYX HD 500+. Interventional Neuroradiol 2005;11:281-6.
  • 20 Urtasun F, Biondi A, Casaco A. Cerebral dural arteriovenous fistula: Percutaneous transvenous embolization. Radiology 1996;199:209-17.
  • 21 Endo S, Kuwayama N, Takaku A, Nishijuma M. Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse sigmoid sinus. J Neurosurg 1998;88:449-56.
  • 22 Houdart E, Maurice JP, Chapot E. Transcranial approach for venous embolization of dural arteriovenous fistulas. J Neurosurg 2002;97:280-6.
  • 23 Shi ZS, Ziegler J, Gonzalez NR, Feng L, Tateshima S, Jahan R, et al. Transarterial embolization of clival dural Arterio- venous fistulae using liquid embolic agents. Neurosurgery 2008;62:408-15.
  • 24 Arat A, Cekirge S, Saatci I, Ozgen B. Transvenous injection of ONYX for casting of the cavernous sinus for the treatment of a carotid cavernous fistula. Neuroradiology 2005;46:1012-5.
  • 25 Mathews MS, Owen CM, Nguyen BV, Kostanian V, Nwagwu CI. Angiographic exclusion of intracranial arteriovenous malformations using ONYX. Neuroradiology J 2007;20:711-7.
  • 26 Mounayer C, Hammami N, Piotin M, Spelle L, Benndorf G, Kessler I, et al. Nidal embolization of Brain Arteriovenous malformations using ONYX in 94 patients. AJNR Am J Neuroradiol 2007;28:518-23.
  • 27 Niemann DB, Molyneux AJ. Embolization of Brain AVMs with ethylene vinyl alcohol copolymer dissolved in DMSO (ONYX Liquid Embolic system). Evidence in a prospective series of 31 patients. J Neurosurg 2002;96:171.
  • 28 Weber W, Kis B, Siekmann R, Kuehne D. Endovascular treatment of intracranial dural arteriovenous malformation with ONYX: Technical aspect. AJNR Am J Neuroradiol 2007;28:371-7.
  • 29 Akin ED, Perkins E, Ross IB. Surgical handling characteristic of an ethylene vinyl alcohol copolymer compared with N-Butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine. J Neurosurg 2003;98:366-70.
  • 30 Jahan R, Murayama Y, Gobin YP. Embolisation of arteriovenous malformations with ONYX: Clinicopathologic results. Neurosurgery 2001;48:984-95.
  • 31 Arat A, Inci S. Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: Technical case report. Neurosurgery 2006;51:169-70.
  • 32 Rezende MT, Piotin M, Mounayer C, Spelle L, Abud DG, Moret J. Dural arteriovenous fistula of the lesser sphenoid wing region treated with ONYX: Technical note. Neuroradiology 2006;48:130-4.
  • 33 Xianli LV, Youxiang LI, Aihua Liu, Ming LV, Zhongxue WU. Transarterial embolization of dural arteriovenous fistula of the Anterior cranial fossa using ONYX-18. Neuroradiol J 2007;20:348-54.
  • 34 Lucas Cde P, Mounayer C, Spelle L, Piotin M, Rezende MT, Moret J. Endoarterial management of Dural Arteriovenous malformations with isolated sinus using ONYX-18: Technical case report. Neurosurgery 2007;61: E293-4.
  • 35 Toulgoat F, Mounayer C, Salles Rezende MT, Piotin M, Spelle L. Transarterial embolization of intracranial dural arteriovenous malformation with ethylene vinyl alcohol copolymer (ONYX-18). J Neuroradiol 2006;33:105-14.
  • 36 Nogueira RG, Dabus G, Rabinov JD, Eskey CJ, Ogilvy CS, Hirsch JA, Pryor JC. Preliminary Experience with ONYX embolization for the treatment of intracranial dural arteriovenous fistula. Am J of Neuroradiol 2008;29:91-7.
  • 37 Carlson AP, Taylor CL, Yonas H. Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (ONYX) arterial embolization as the primary modality: Short term results. J Neurosurg 2007;107:1120-5.
  • 38 Cognard C, Januel AC, Silva NA Jr. Tall P. Endovascular treatment of Intracranial dural arteriovenous fistula with cortical venous drainage: New Management using ONYX. AJNR Am J Neuroradiol 2008;29:235-41.