Document Detail


Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx.
MedLine Citation:
PMID:  17989374     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: DAVFs (dural arteriovenous fistulas) represent one of the most dangerous types of intracranial AV shunts. Most of them are cured by arterial or venous embolization, but surgery/radiosurgery can be required in case of failure. Our goal was to reconsider the endovascular treatment strategy according to the new possibilities of arterial embolization using non polymerizing liquid embolic agent. MATERIALS AND METHODS: Thirty patients were included in a prospective study during the interval between July 2003 and November 2006. Ten of these had type II, 8 had type III, and 12 had type IV fistulas. Sixteen presented with hemorrhage. Five had been treated previously with other embolic materials. RESULTS: Complete angiographic cure was obtained in 24 cases. Of these 24 cures, 20 were achieved after a single procedure. Cures were achieved in 23 of 25 patients who had not been embolized previously and in only 1 of 5 previously embolized patients. Among these 24 patients, 23 underwent a follow-up angiography, which has confirmed the complete cure. Partial occlusion was obtained in 6 patients, 2 were cured after additional surgery, and 2 underwent radiosurgery. Onyx volume injected per procedure ranged from 0.5 to 12.2 mL (mean, 2.45 mL). Rebleeding occurred in 1 completely cured patient at day 2 due to draining vein thrombosis. One patient had cranial nerve palsy that resolved. Two ethmoidal dural arteriovenous fistulas were occluded. All 10 of the patients with sinus and then CVR drainage were cured. CONCLUSION: Based on this experience, we believe that Onyx may be the treatment of choice for many patients with intracranial dural arteriovenous fistula (ICDAVF) with direct cortical venous reflux (CVR). The applicability of this new embolic agent indicates the need for reconsideration of the global treatment strategy for such fistulas.
Authors:
C Cognard; A C Januel; N A Silva; P Tall
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2007-11-07
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  29     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-14     Completed Date:  2008-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  235-41     Citation Subset:  IM    
Affiliation:
Department of Neuroradiology, Hopital Purpan, University of Toulouse, Toulouse, France. cognard.c@chu-toulouse.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Central Nervous System Vascular Malformations / radiography,  therapy
Cerebral Angiography
Cerebral Hemorrhage / etiology,  prevention & control*,  radiography
Cerebral Veins / abnormalities*,  radiography
Dimethyl Sulfoxide / therapeutic use*
Embolization, Therapeutic / instrumentation,  methods*
Female
Humans
Intracranial Arteriovenous Malformations / radiography,  therapy*
Male
Middle Aged
Polyvinyls / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Onyx copolymer; 0/Polyvinyls; 67-68-5/Dimethyl Sulfoxide

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