Department of Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
J Neurointerv Surg. 2011 Sep;3(3):224-8. doi: 10.1136/jnis.2010.004119. Epub 2011 Feb 10.
To report our experience with transarterial ONYX embolization of intracranial non-cavernous dural arteriovenous fistulas (DAVFs) with or without cortical venous reflux.
Retrospective analysis of transarterial ONYX embolization in 20 patients with 21 DAVFs, presenting with intracranial hemorrhage (n=7), pulsatile bruit (n=7), vertigo (n=3), non-pulsatile bruit (n=1), headache (n=1) and epilepsy (n=1). Risk grading of DAVFs was Borden type I (n=6), type II (n=4) and type III (n=11).
18 of 21 (85.7%) DAVFs were angiographically occluded immediately after embolization, with ONYX embolization only, in either one (n=12) or two sessions (n=2); with a combination of ONYX and glue or transvenous coiling in a single session (n=2) or in two sessions (n=1); or after previous transvenous coiling/glue embolization (n=1). At the 6 (4-14) month control digital subtraction angiography (DSA), available in 14 of 18 occluded DAVFs, one patient showed a small residual fistula (17/21 or 81% occluded). Mid-term DSA was not available because of early death (n=2) or patients were awaiting the examination (n=2). In three cases, treatment was incomplete. Of six Borden type I DAVFs, four were cured and two partially occluded with resolution of symptoms. In two DAVFs, neurosurgical access to the feeding artery allowed distal microcatheterization and successful embolization.
Transarterial ONYX embolization offers an effective and safe treatment for all non-cavernous DAVFs, whether with or without cortical venous reflux.
报告我们采用经动脉 ONYX 栓塞治疗颅内非海绵窦硬脑膜动静脉瘘（DAVF）的经验，包括有或无皮质静脉反流的情况。
回顾性分析了 20 例 21 个 DAVF 患者的经动脉 ONYX 栓塞治疗，这些患者表现为颅内出血（n=7）、搏动性杂音（n=7）、眩晕（n=3）、非搏动性杂音（n=1）、头痛（n=1）和癫痫（n=1）。DAVF 的风险分级为 Borden Ⅰ型（n=6）、Ⅱ型（n=4）和Ⅲ型（n=11）。
21 个 DAVF 中有 18 个（85.7%）在栓塞后即刻通过单纯 ONYX 栓塞、1 次或 2 次栓塞，或 ONYX 联合胶或经静脉弹簧圈栓塞 1 次或 2 次，或在先前经静脉弹簧圈/胶栓塞后被完全闭塞，21 个 DAVF 中 18 个（85.7%）即刻被完全闭塞。18 个完全闭塞的 DAVF 中有 14 个（88.9%）在 6（4-14）个月的数字减影血管造影（DSA）随访中仍保持闭塞，1 例患者显示小的残余瘘（17/21 或 81%闭塞）。由于早期死亡（n=2）或患者等待检查（n=2），14 个中有 6 个（6/14 或 42.9%）的中期 DSA 结果不可用。在 3 例中，治疗不完全。6 个 Borden Ⅰ型 DAVF 中，4 个治愈，2 个部分闭塞，症状缓解。在 2 个 DAVF 中，神经外科入路可以对供血动脉进行远端微导管操作，从而成功栓塞。
经动脉 ONYX 栓塞治疗所有非海绵窦 DAVF，无论是有皮质静脉反流还是无皮质静脉反流，均是一种有效且安全的治疗方法。
