Transarterial Embolization of Tentorial Dural Arteriovenous Fistulas with Onyx 18

Abstract

Dural arteriovenous fistulas (DVAFs) have been reported to be treated transarterially with Onyx 18. We present a series of tentorial DAVFs treated by transarterial embolization with Onyx 18 over an 18-month period. Eight patients with tentorial DAVFs were treated between September 2005 and February 2007. All patients were treated transarterially with Onyx 18. The clinical presentation, treatment strategies and results were studied. Eight patients presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in every patient, classifying the lesions as Cognard Type IV. Post treatment angiography demonstrated complete obliteration in six cases. Clinical follow up ranged from six to 14 months. One patient experienced neurological decline after endovascular treatment and exhibited clinical improvement. There were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in seven patients, fair in one case. Transarterial embolization of tentorial DAVF is feasible and may result in complete occlusion of the fistulous connection with liquid nonadhesives.