Document Detail

Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux.
MedLine Citation:
PMID:  19101880     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Our purpose was to present our experience regarding embolization of intracranial dural arteriovenous fistulas (DAVFs) with cortical venous reflux using Onyx, a non-adhesive liquid embolic agent. MATERIALS AND METHODS: From January 2006 to December 2007, 16 patients (12 men and 4 women) with a mean age of 61 years (range 42 - 78) with an intracranial DAVF with cortical venous reflux underwent at least one transarterial embolization using Onyx. According to the Cognard classification, 2 lesions were grade V, 5 were grade IV, 6 were grade III, 2 were grade IIa+b, and 1 was grade IIb. The clinical presentation included 5 hemorrhagic deficits, 10 non-hemorrhagic manifestations, and 1 patient was asymptomatic. RESULTS: Twenty-four embolization sessions were performed in 16 patients with an average of 3 arterial feeders (range 1 - 9) embolized per DAVF. Immediately after embolization, complete occlusion was achieved in 9/16 (56%) patients after the first session. Further postembolization surgical treatment was performed in 3 patients. Partial reperfusion occurred in 1 patient at the time of mean follow-up of 3.7 months (range 0 - 12). Treatment has been completed for 11/16 patients with angiographic cure in 10/11 (91%). An infratentorial bleeding complication related to embolization occurred in one patient with temporary worsening of the patient's gait disturbance. At the time of mean clinical follow-up of 4.5 months (range 0 - 12), no procedure-related permanent morbidity was added to our cohort. CONCLUSION: According to our experience, embolization of intracranial DAVFs with cortical venous drainage using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. In very complex DAVFs additional embolization material might be necessary, and in some cases surgery is warranted.
V Panagiotopoulos; W Möller-Hartmann; S Asgari; I E Sandalcioglu; M Forsting; I Wanke
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2008-12-19
Journal Detail:
Title:  RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin     Volume:  181     ISSN:  1438-9010     ISO Abbreviation:  Rofo     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-28     Completed Date:  2009-03-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7507497     Medline TA:  Rofo     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  129-38     Citation Subset:  IM    
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen.
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MeSH Terms
Cerebral Cortex / blood supply*,  surgery
Cerebral Veins / surgery*
Cerebrovascular Disorders / complications,  surgery*
Combined Modality Therapy
Dimethyl Sulfoxide / administration & dosage*
Embolization, Therapeutic / methods*
Hemostatics / administration & dosage
Intracranial Arteriovenous Malformations / complications,  therapy*
Middle Aged
Polyvinyls / administration & dosage*
Premedication / methods*
Treatment Outcome
Reg. No./Substance:
0/Hemostatics; 0/Onyx copolymer; 0/Polyvinyls; 67-68-5/Dimethyl Sulfoxide

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