Arat Anil, Inci Servet
Interventional Neuroradiology, Baylor College of Medicine, Houston, Texas, USA.
Neurosurgery. 2006 Jul;59(1 Suppl 1):ONSE169-70; discussion ONSE169-70. doi: 10.1227/01.NEU.0000220113.34075.40.
The endovascular treatment of a complex superior sagittal sinus dural arteriovenous fistula with ethylene vinyl alcohol copolymer (Onyx) in one session is described.
A 54-year-old man presented with dizziness and a bruit. A cerebral angiogram demonstrated a superior sagittal sinus dural arteriovenous fistula with a patent superior sagittal sinus that was supplied via multiple branches of the external carotid arteries bilaterally and the left anterior and middle cerebral arteries. Drainage was mainly through the superior sagittal sinus and, only in part, retrogradely through the cortical veins. A decision was made to proceed with endovascular treatment followed by surgery.
Transarterial injection of one pedicle of middle meningeal artery on both sides with Onyx resulted in complete obliteration of the dural supply and some of the pial supply to the malformation without complications. The superior sagittal sinus remained patent. Based on this result, surgical treatment was cancelled. The residual pial supply had disappeared by the 10-month angiographic follow-up examination and the patient remained neurologically intact and without symptoms.
Definitive treatment may be attained with Onyx in dural arteriovenous fistulas. The potential of Onyx for use as a permanent embolic agent in dural arteriovenous fistulae needs to be investigated.
描述经血管内一次性使用乙烯-乙烯醇共聚物（Onyx）治疗复杂的上矢状窦硬脑膜动静脉瘘。
一名54岁男性出现头晕和血管杂音。脑血管造影显示上矢状窦硬脑膜动静脉瘘，上矢状窦通畅，由双侧颈外动脉的多个分支以及左侧大脑前动脉和大脑中动脉供血。引流主要通过上矢状窦，部分通过皮质静脉逆行引流。决定先进行血管内治疗，然后进行手术。
经动脉向双侧脑膜中动脉的一个分支注射Onyx，导致硬脑膜供血以及部分软脑膜供血完全闭塞，畸形无并发症。上矢状窦仍保持通畅。基于此结果，取消了手术治疗。在10个月的血管造影随访检查中，残留的软脑膜供血消失，患者神经功能完好且无症状。
Onyx可用于硬脑膜动静脉瘘的确定性治疗。Onyx作为硬脑膜动静脉瘘永久性栓塞剂的潜力有待研究。
