Embolization of tentorial dural arteriovenous fistula with ONYX-18

Abstract

Objective To assess the therapeutic effect of arterial embolization with ONYX-18 for treatment of tentorial dural arteriovenous fistula (DAVFs). Methods The clinical data (including the disease history, radiographic examination, surgical record, and follow-up data) of 4 patients with DAVF treated between March and July, 2008 were retrospectively analyzed. Of the 4 patients, one had acute subaraclmoid hemorrhage, and 3 exhibited progressive neurological deficits. The fistula orifice was located on the top of the tentorium in 2 cases, on the left tentorium in one case and in the posterior tentorium in the other. Type Ⅱ b DAVF was found in 2 cases, type Ⅲ in one case and type IV in the other ease. All the 4 patients underwent arterial embolization with ONYX-18, with ONYX-18 dose of 1.5, 3.5, 9, and 12 mL, respectively. One patient underwent ventricuioperitoneal shunt after the embolization because of obstructive hydrocephalus. Results The fistulae were embolized completely in 3 cases, and in one patient, a small quantity of blood supply to the fistula orifice was present fi'om the occipital artery, but the blood flow velocity was obviously reduced. Follow-up of the patients for 3 months revealed no occurrence of the former symptoms after the embolization. Conclusion ONYX-18 injection through one single feeding artery after placement of the micro-catheter at the appropriate position allows effective embolization of the fistula orifice, the supplying arteries and the venous ends to achieve safe and effective embolization of DAVF. Key words: Tentorial dural arteriovenous fistula; Embolization, therapeutic; ONYX-18