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Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Published online by Cambridge University Press:  02 December 2014

Jason Chew ,
Alain Weill ,
François Guilbert ,
Jean Raymond ,
Marie-Eve Audet  and
Daniel Roy
Jason Chew*
Affiliation:
Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC
Alain Weill
Affiliation:
Département de radiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
François Guilbert
Affiliation:
Département de radiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
Jean Raymond
Affiliation:
Département de radiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
Marie-Eve Audet
Affiliation:
Département de radiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
Daniel Roy
Affiliation:
Département de radiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
*
Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
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Abstract

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Purpose:

To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx.

Materials & Methods:

Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months).

Results:

Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose.

Conclusion:

Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 168 - 175
Copyright
Copyright © The Canadian Journal of Neurological 2009

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