Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing 100050, China.
Eur J Radiol. 2011 Dec;80(3):e385-8. doi: 10.1016/j.ejrad.2010.08.029. Epub 2010 Sep 15.
Embolization of grade III-V intracranial DAVFs using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. This article is to evaluate the role of transarterial Onyx embolization in the treatment of grade I and II intracranial dural arteriovenous fistulas (DAVFs), including its limitations and risks.
We retrospectively studied consecutive 26 patients (8 women and 18 men) treated for an grade I and II intracranial DAVF since 2006 in whom a transarterial approach was attempted with Onyx-18 embolization. There were 18 transverse-sigmoid sinus, 4 cavernous sinus, 2 superior sagittal sinus, 1 inferior petrosal sinus and 1 intradiploic fistulas. Five fistulas were Type I, 8 were Type IIa, and 13 were Type IIa+b, according to the Cognard classification. The mean clinical follow-up period was 15.6 months.
Anatomic cure was proven in 13 patients (50%) and clinical cure was obtained in 17 cases (65.4%). These 13 cures were achieved after a single procedure. All these 13 patients underwent a follow-up angiography, which has confirmed the complete cure. Partial occlusion was obtained in 13 patients. Complications were as follows: 2 cardiac Onyx migration, 2 reflexive bradyarrythmia, 1 transient visual hallucination, 2 transient fifth nerve palsies and 1 permanent seventh nerve palsy in inferior petrosal sinus DAVF.
Based on this experience, grade I and II intracranial DAVFs may be treated with transarterial Onyx embolization to reduce the shunted blood flow and to facilitate subsequent transvenous embolization or surgery.
使用 Onyx 栓塞 III-V 级颅内 DAVF 是可行的，具有良好的中期随访结果，提示稳定性。本文旨在评估经动脉 Onyx 栓塞在治疗 I 级和 II 级颅内硬脑膜动静脉瘘（DAVF）中的作用，包括其局限性和风险。
我们回顾性研究了 2006 年以来连续 26 例 I 级和 II 级颅内 DAVF 患者，经动脉途径采用 Onyx-18 栓塞治疗。18 例为横窦-乙状窦，4 例为海绵窦，2 例为上矢状窦，1 例为下岩窦，1 例为颅板内瘘。根据 Cognard 分类，5 例为 I 型，8 例为 IIa 型，13 例为 IIa+b 型。平均临床随访时间为 15.6 个月。
13 例（50%）患者达到解剖治愈，17 例（65.4%）患者获得临床治愈。这些治愈均通过单次治疗获得。所有 13 例患者均接受了随访血管造影检查，结果证实完全治愈。13 例患者获得部分闭塞。并发症如下：2 例心脏 Onyx 迁移，2 例反射性心动过缓，1 例短暂性幻视，2 例短暂性第 V 颅神经麻痹和 1 例下岩窦 DAVF 永久性第 VII 颅神经麻痹。
根据本经验，I 级和 II 级颅内 DAVF 可采用经动脉 Onyx 栓塞治疗，以减少分流血流，促进随后的经静脉栓塞或手术治疗。
