Transarterial embolization of petrosal dural arteriovenous fistula (dAVF): Feasible and successful in the post-Onyx era

Abstract

Background: Intracranial dural arteriovenous fistula (dAVF) is a rare arteriovenous malformation with potentially severe complications. This study investigates the efficacy and safety of transarterial embolization (TAE) in treating petrous dAVFs through a retrospective analysis and literature review. Case Description: A retrospective analysis of six patients with petrous dAVFs treated with TAE was conducted, accompanied by a systematic literature review to evaluate treatment outcomes. Data collection included patient characteristics, clinical presentation, Borden–Shucart and Cognard classifications, treatment specifics, and overall outcomes. TAE, particularly utilizing Onyx, demonstrated favorable outcomes in our six patients. Regarding literature review results, 102 articles were identified through PubMed Mesh tool search, but only five were included after careful evaluation. In addition, one article was manually added after searching for the remaining articles. Combining our six cases with literature findings, 79.8% (n = 75) of patients undergoing TAE achieved a cure with the technique, though Onyx was reported in only 13.9% (n = 13) of TAE cases. Complications were observed in 11.7% (n = 11) of TAE cases. Conclusion: Our presented cases and literature review suggest that the TAE of dAVFs is feasible and curative for selected cases of petrous dAVFs. However, the complexity of these lesions and the availability of other treatment modalities should be taken into consideration to optimize cure rates and patient outcomes.