Curative Onyx embolization of tentorial dural arteriovenous fistulas

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors conducted a study to review their experience with tentorial dural arteriovenous fistulas (DAVFs) treated with transarterial endovascular embolization in which Onyx was used.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors reviewed prospectively collected data in 9 patients with tentorial DAVFs treated with Onyx embolization between 2008 and 2011. Information reviewed included clinical presentation, angiographic features, treatment, and clinical and radiologically documented outcome. Clinical follow-up was available in every patient. Radiological follow-up studies were available in 8 of 9 patients (mean follow-up 4.6 months).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Six of 9 patients had complete angiographic obliteration (in 5 this was confirmed by a follow-up angiogram obtained 3–6 months later), and 2 patients had near-complete obliteration (faint filling of the venous drainage in the late venous phase). One patient had partial obliteration and required surgical disconnection. In all patients with complete obliteration, transarterial embolization was performed through the posterior branch of the middle meningeal artery. There were no procedural complications, and no morbidity or mortality resulted from Onyx embolization.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Transarterial Onyx embolization is a valid, effective, and safe alternative to surgical disconnection in many patients with tentorial DAVFs. The presence of an adequate posterior branch of the middle meningeal artery is critical to achieve a microcatheter position distal enough to increase the likelihood of complete obliteration.</jats:p></jats:sec>

Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

“…With the advent of newer embolic agents (Onyx, Covidien), we have been able to safely and effectively obliterate many tentorial DAVFs. 12 In our experience, a sine qua non for successful embolization is the presence of a well-developed posterior branch of the middle meningeal artery supplying the lesion. This branch is relatively straight and allows distal catheterization, which in turn increases the likelihood of penetration of the embolic agent well into the proximal draining vein.…”

Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas

“…The occipital artery, the second most likely artery to supply a dAVF in this series, follows a more tortuous, transosseous course which inhibits microcatheter access, navigation, and Onyx penetration. The same is true for a number of other tributaries of other branches of the external carotid, internal carotid, and vertebral arteries that supply dAVFs including the posterior middle meningeal artery, another branch that frequently supplies dAVF of the posterior cranial fossa and tentorium cerebelli and incisura (Puffer et al, ). However, the tortuosity of the posterior meningeal artery after initial take off from the vertebral artery frequently precludes distal catheterization.…”

Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review

“…Although proximal Onyx reflux may occur with a high margin of safety in the middle meningeal artery, reflux should not be allowed in proximity to the level of the foramenspinosumtoavoidinadvertentcompromiseofthearterialsupplyto the trigeminal and facial nerves. 16 Even though we have attempted to summarize data on all published series of treated TDAVFs, our study has certain limitations. The results of separate case series were published by multiple authors who reported independently assessed data and who determined different specific variables that are included in this article.…”