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Clin Neuroradiol. 2018 Dec;28(4):579-584. doi: 10.1007/s00062-017-0615-7. Epub 2017 Aug 11.

Safety of Onyx Transarterial Embolization of Skull Base Dural Arteriovenous Fistulas from Meningeal Branches of the External Carotids also Fed by Meningeal Branches of Internal Carotid or Vertebral Arteries.

Author information

1
Diagnostic Imaging Department, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, 04024-002, São Paulo, SP, Brazil. tgabud@gmail.com.
2
Interventional Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise-Paré, 75010, Paris, France. tgabud@gmail.com.
3
Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Hemodinâmica Bloco A, 4th floor, 05651-901, São Paulo, SP, Brazil. tgabud@gmail.com.
4
Interventional Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise-Paré, 75010, Paris, France.
5
Interventional Neuroradiology, Campus Universitário, 14048-900, Monte Alegre, SP, Brazil.
6
Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Hemodinâmica Bloco A, 4th floor, 05651-901, São Paulo, SP, Brazil.
7
Diagnostic Imaging Department, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, 04024-002, São Paulo, SP, Brazil.

Abstract

PURPOSE:

To analyze the angiographic and clinical results of transarterial embolization with Onyx (Medtronic-Covidien, Irvine, CA) in dural arteriovenous fistulas (DAVFs) partially fed by arteries arising from the carotid siphon or the vertebral arteries.

METHODS:

We isolated 40 DAVFs supplied by either the tentorial artery of the internal carotid artery (ICA) or the posterior meningeal artery of the vertebral artery. These DAVFs were embolized with Onyx through the middle meningeal artery or the occipital artery. We reviewed the occurrence of reflux into the arteries of carotid or vertebral origin.

RESULTS:

In all the cases, reflux occurred into the first millimeters of the DAVF arterial feeders arising from carotid or vertebral arteries but slowly enough to be controlled by interruption of Onyx injection. Reflux was always minimal and Onyx never reached the ostium of the arteries. No cerebral ischemic complications occurred in our series.

CONCLUSION:

The behavior of Onyx is clearly different from that of cyanoacrylate glue, resulting in superior control during injection. Reflux into arteries arising from the ICA or vertebral artery during DAVF treatment always carries a risk of unintentional non-target embolization of normal cerebral vasculature but Onyx appears to be safe in this situation.

KEYWORDS:

Arteriovenous malformation; Dangerous anastomosis; Dural arteriovenous fistula; Endovascular embolization; Transarterial Onyx embolization

PMID:
28801711
DOI:
10.1007/s00062-017-0615-7

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