Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2009 Dec;65(6 Suppl):132-9; discussion 139-40. doi: 10.1227/01.NEU.0000345949.41138.01.
An endovascular approach is often the first-line treatment of dural arteriovenous fistulae (DAVFs). Information on the use of Onyx (ev3 Neurovascular, Irvine, CA) for treating DAVFs, however, is limited. Therefore, we present our early experience, technical considerations, and complications associated with the use of Onyx for DAVF embolization.
Twenty-eight patients with 29 DAVFs treated with Onyx embolization were included in this analysis. Hospital records, operative reports, and angiograms were reviewed and analyzed.
Forty Onyx procedures, including 39 transarterial and 1 transvenous approaches, were performed. Fifty-one external carotid artery branches, 8 posterior meningeal artery branches, and 3 internal carotid artery branches were used for Onyx embolization. Branches of the middle meningeal artery were embolized 32 times, and the occipital artery was embolized 15 times. Twenty-one fistulae (72%) were cured angiographically with endovascular therapy. Transarterial embolization via the middle meningeal artery cured 12 DAVFs (41%). Four complications (9.7%) were recorded, including 3 transient (7.3%) and 1 permanent neurological deficits (2.4%). Follow-up imaging, which was available for 8 fistulae with angiographic cures, showed no evidence of recurrence.
Transarterial Onyx embolization of external carotid artery branches, particularly the middle meningeal artery, offers a high likelihood of cure. This technique provides a safe and effective method of embolization with few side effects and complications. However, long-term follow-up is needed to establish its efficacy.
血管内介入治疗通常是硬脑膜动静脉瘘（DAVF）的一线治疗方法。然而，关于使用 Onyx（ev3 神经血管，欧文，加利福尼亚州）治疗 DAVF 的信息有限。因此，我们介绍了我们在使用 Onyx 栓塞治疗 DAVF 方面的早期经验、技术考虑因素和相关并发症。
回顾性分析 28 例 29 个 DAVF 患者接受 Onyx 栓塞治疗的临床资料。分析患者的住院病历、手术记录和血管造影资料。
共进行了 40 例 Onyx 栓塞操作，包括 39 例经动脉入路和 1 例经静脉入路。使用了 51 条颈外动脉分支、8 条脑膜后动脉分支和 3 条颈内动脉分支进行 Onyx 栓塞。中脑膜动脉分支栓塞 32 次，枕动脉栓塞 15 次。21 例（72%）患者经血管内治疗后达到影像学治愈。经中脑膜动脉的经动脉栓塞治愈了 12 例 DAVF（41%）。记录到 4 例并发症（9.7%），包括 3 例（7.3%）短暂性和 1 例（2.4%）永久性神经功能缺损。对 8 例达到影像学治愈的瘘管进行了随访影像学检查，均未见复发迹象。
经颈外动脉分支，特别是中脑膜动脉的 Onyx 栓塞治疗，具有很高的治愈率。该技术提供了一种安全有效的栓塞方法，副作用和并发症少。然而，需要长期随访以确定其疗效。
