Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA.
J Neurointerv Surg. 2011 Mar;3(1):5-13. doi: 10.1136/jnis.2010.003707. Epub 2011 Jan 6.
Traditional endovascular treatment of cranial dural arteriovenous fistulas (DAVFs) consists of a transarterial approach with n-butylcyanoacrylate (nBCA) or a transvenous approach with coil embolization. The advent of Onyx in the endovascular arsenal potentially offers a high probability of obliteration of these vascular lesions through a purely transarterial route.
A retrospective review of the Barrow Neurological Institute endovascular database between October 2005 and November 2009 highlighted 50 patients with 63 cranial DAVFs that were treated with transarterial Onyx, with and without adjuvant embolysates, for a total of 76 embolization procedures. Hospital records, cerebral angiography and other diagnostic imaging and clinical visits were reviewed.
At a median follow-up of 5 months (range 0-25 months), complete angiographic cure was obtained in 41 patients with 50 (79%) DAVFs after transarterial embolization using Onyx combined with other embolysates. When Onyx was used as the sole embolic agent, 32 of 37 DAVFs (87%) in 29 (of 33) patients achieved angiographic cure. Subgroup analysis showed that by using the middle meningeal artery (MMA) as a conduit for primary Onyx embolization, angiographic cures were achieved in 27 of the 37 DAVFs (73%). Periprocedural complications occurred in six (7.9%) sessions in one patients (8%). Only one patient had a permanent complication (2%) with unimproved cranial nerve palsies.
Transarterial Onyx embolization of cranial DAVFs, particularly using the MMA as a conduit, is a safe and effective curative therapy.
传统的颅内外侧动静脉瘘（DAVF）的血管内治疗方法包括经动脉途径使用 n-丁基氰丙烯酸酯（nBCA）或经静脉途径使用线圈栓塞。Onyx 的出现为通过单纯经动脉途径对这些血管病变进行高概率闭塞提供了可能。
对 2005 年 10 月至 2009 年 11 月巴罗神经学研究所血管内数据库进行回顾性分析，突出显示了 50 例 63 例颅内外侧动静脉瘘患者，采用经动脉 Onyx 治疗，有或无辅助栓塞剂，共进行了 76 次栓塞治疗。对医院记录、脑血管造影和其他诊断影像学及临床随访进行了评估。
在中位数为 5 个月（范围 0-25 个月）的随访中，经动脉栓塞使用 Onyx 联合其他栓塞剂治疗 41 例患者中的 50 例（79%）DAVF 完全获得了血管造影治愈。当 Onyx 被用作唯一的栓塞剂时，33 例患者中的 29 例（37 例中的 32 例）中的 37 例 DAVF 达到了血管造影治愈。亚组分析显示，通过使用脑膜中动脉（MMA）作为原发性 Onyx 栓塞的导管，在 37 例 DAVF 中的 27 例（73%）中达到了血管造影治愈。在 1 例患者（8%）的 6 次（7.9%）治疗中发生了围手术期并发症。只有 1 例患者（2%）出现永久性并发症（未改善的颅神经麻痹）。
经动脉 Onyx 栓塞治疗颅内外侧动静脉瘘，特别是使用 MMA 作为导管，是一种安全有效的治疗方法。
