Onyx© Embolization of Dural Arteriovenous Fistulae at the Cranio-Cervical Junction (P8-5.024)

Abstract

<h3>Objective:</h3> To report two cases of CRC fistula treated successfully with endovascular embolization with Onyx©. <h3>Background:</h3> Dural arteriovenous fistula (dAVF) are rare vascular malformations; a rare subset of this group are dAVFs located at the cranio-cervical junction. Subarachnoid hemorrhage (SAH) is one of the possible neurological complications of cranio-cervical (CRC) fistula rupture. Treatment options include radiosurgery, endovascular embolization and/or open surgery. The use of liquid embolic agent is a reasonable option for endovascular treatment. <h3>Design/Methods:</h3> A single institution retrospective case report identified two case of cranio-cervical junction (CRC) fistulae that were treated successfully with Onyx© embolization. <h3>Results:</h3> Two patients were identified to have cranio-cervical junction DAVF in which one patient presented with SAH, and the 2^nd patient presented with bulbar symptoms due to rapidly worsening edema in the brainstem. Both fistulas were supplied from the vertebral artery; one at the level of Dural ring of the vertebral artery and the other at the jugular foramen level which was also supplied by ascending pharyngeal artery. Onyx© embolization was the treatment of choice in both cases. The Onyx© embolization resulted in 80% reduction of the fistula nidus in the first case, and complete occlusion of the fistula in the second and the third case. The 6 months follow-up revealed complete occlusion of both fistulas with complete neurological recovery <h3>Conclusions:</h3> This case series suggests that the treatment of CRC fistulae with Onyx© embolization is efficacious with good clinical outcomes. <b>Disclosure:</b> Dr. Gharaibeh has nothing to disclose. Dr. Al-Chalabi has nothing to disclose. Dr. Oliver has nothing to disclose. Dr. Jumaa has nothing to disclose.