Endovascular treatment of congenital brain arteriovenous fistulas with combination of detachable coils and onyx liquid embolic agent

Abstract

Congenital brain arteriovenous fistulas (BAVFs) are rare vascular lesions, and conservative management was associated with a high mortality rate. We report our experience in the treatment of congenital BAVFs using detachable coils and Onyx liquid embolic agent. Over the past 5 years, 15 patients with congenital BAVFs were treated endovascularly at our hospital using detachable coils and Onyx-34. All patients were clinically followed-up for 12-48 months. We retrospectively reviewed the medical records, cerebral angiograms, and endovascular reports for each patient. There were 15 patients with a total of 16 BAVFs (six men and nine women, with a mean age of 29.4 years). The clinical presentations were intracranial hemorrhage in six patients, headaches in four patients, and seizure in three patients, with two patients diagnosed incidentally. In all of the cases, transarterial microcatheterization was performed, 13 patients were treated with a combination of detachable coils and Onyx-34, and two with balloon-assisted coils and Onyx-34 embolization. There was no significant morbidity or mortality. All BAVF-related symptoms resolved immediately or gradually on clinical follow-up. Immediate angiographic obliteration was achieved in all patients. The fistulas remained closed in all patients, as ascertained by follow-up angiograms. No new neurological deficits related to the procedure were detected. In our experience, the endovascular treatment of BAVFs with combination of detachable coils and Onyx is feasible, safe, and effective. This technique affords more control in the Onyx injection and minimizes the risk of distal embolization.