Onyx Migration in the Endovascular Management of Intracranial Dural Arteriovenous Fistulas
- 1 September 2009
- journal article
- research article
- Published by SAGE Publications in Interventional Neuroradiology
- Vol. 15 (3), 301-308
- https://doi.org/10.1177/159101990901500307
Abstract
Onyx migration in the endovascular treatment of dural arteriovenous fistulas (dural AVFs) is uncommon. We describe five cases of Onyx migration to the heart and draining vein and its avoidance. Between February 2007 and August 2008, Onyx migration was encountered in five patients with dural AVFs treated endovascularly at our institute. Procedures performed under general anesthesia consisted of two arterial approaches and three venous approaches. Two patients with dural AVFs involving the transverse-sigmoid sinus were treated by transarterial embolization using Onyx-18 via the occipital artery and the posterior branch of the middle meningeal artery, respectively. A piece of Onyx was found in the right ventricle on post-embolization chest X-ray film in both patients, one developed tricuspid valve dysfunction requiring thoracic surgery and one was asymptomatic. The other three patients were treated with a combination of Onyx (34 or 18) and coils transvenously with venous Onyx migration leading to draining vein occlusion, one with dural AVF involving the tentorium died from venous rupture, two patients with bilateral dural AVFs of the cavernous sinus (one with deterioration of ocular symptoms and one without symptoms). Postoperative digital subtraction angiography confirmed the elimination of dural AVF in one patient, and residual fistulae in three patients. The follow-up study ranging from two to nine months (average, 4.5 months). Three patients recovered to their full activities, while one had visual disturbance. Although Onyx has been considered a controllable embolic agent, its migration to other locations causing clinical deterioration can occur. This problem should be noted and prevented.Keywords
This publication has 26 references indexed in Scilit:
- Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18Journal of Neurosurgery, 2008
- A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery–cavernous sinus fistulaJournal of Neurosurgery, 2008
- Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: New Management Using OnyxAmerican Journal Of Neuroradiology, 2008
- ENDOARTERIAL MANAGEMENT OF DURAL ARTERIOVENOUS MALFORMATIONS WITH ISOLATED SINUS USING ONYX-18Operative Neurosurgery, 2007
- Surgical disconnection of cortical venous reflux as a treatment for Borden type II dural arteriovenous fistulaeActa Neurochirurgica, 2007
- SURGICAL TREATMENT OF HIGH-RISK INTRACRANIAL DURAL ARTERIOVENOUS FISTULAENeurosurgery, 2007
- Dural AVM supplied by the ophthalmic arteryBritish Journal of Neurosurgery, 2007
- Treatment of a Superior Sagittal Sinus Dural Arteriovenous Fistula with Onyx: Technical Case ReportOperative Neurosurgery, 2006
- Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case reportSurgical Neurology, 2006
- Reversible Dural Arteriovenous Malformation-induced Venous Ischemia As a Cause of DementiaNeurosurgery, 1995