E-092 Transvenous embolization of cavernous sinus dural arteriovenous fistula with ONYX: a single center experience

Abstract

Objective The therapeutic challenge of cavernous sinus dural arteriovenous fistula (CSDAVF) is the anatomy of the CS, which consists of a network of interconnected venous pockets, one or many of which may receive shunt arteries. Although the standard treatment of CSDAVF is coil packing, a substantial number of platinum coils are required to treat the fistulas in most cases, and the treatments may result in incomplete occlusion because of complicating venous structures. Onyx (ethylene-vinyl alcohol copolymer) can be penetrated and might be able to reduce the number of platinum coils. Despite inherent advantages of the liquid embolic material, the neuro- and angiotoxic effects of DMSO and clinical outcomes are still not well documented. The purpose of this study is to evaluate the single-center experience of transvenous treatment of CSDAVFs with the DMSO-based liquid embolic material, ONYX. Methods We retrospectively reviewed 52 cases whose CSDAVFs were treated in our hospital between 2005 and 2016. Four patients treated with transarterial embolization and 2 patients with transorbital embolization were excluded from this study. Their hospital records, angiograms and operation reports were reviewed. Results There were total of 46 patients (13 male and 37 female, age 32–89 years) treated transvenously using Onyx. Thirty patients had a combination of coils and Onyx and 16 patients had Onyx embolization used for treatment. Complete obliteration immediately after the treatment was achieved in 42 patients (91%). There were 5 (11%) periprocedural complications including transient worsening of cranial nerve palsy (n=2, 4%), transient worsening of eye symptoms (n=1, 2%) a transient thromboembolic event (n=1, 2%) and alopecia (n=1, 2%). No patients developed a bradycardia during DMSO injection. Conclusion In our case series, transvenous embolization of CSDAVFs using Onyx has favorable long-term clinical outcomes with low complication rates. Cranial nerve palsy and bradycardia caused by DMSO were uncommon, but should be carefully monitored. Disclosures N. Kaneko: None. S. Tateshima: 1; C; Medtronic. 2; C; Medtronic. V. Szeder: 1; C; Medtronic. F. Liang: None. A. Mowla: None. R. Jahan: 1; C; Medtronic. 2; C; Medtronic. F. Vinuela: None. G. Duckwiler: 1; C; Medtronic.