Treatment of a superior sagittal sinus dural arteriovenous fistula with onyx : Technical case report

• Published in: Neurosurgery Vol. 59; no. 1; pp. 169 - 170
• Main Authors: ARAT, Anil, INCI, Servet
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-07-2006
• Subjects: Anterior Cerebral Artery - anatomy & histology; Anterior Cerebral Artery - diagnostic imaging; Anterior Cerebral Artery - pathology; Biological and medical sciences; Carotid Artery, External - anatomy & histology; Carotid Artery, External - pathology; Carotid Artery, External - surgery; Central Nervous System Vascular Malformations - physiopathology; Central Nervous System Vascular Malformations - therapy; Cerebral Angiography; Cranial Sinuses - pathology; Cranial Sinuses - physiopathology; Cranial Sinuses - surgery; Dimethyl Sulfoxide - therapeutic use; Dura Mater - blood supply; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Humans; Intraoperative Complications - prevention & control; Male; Medical sciences; Meningeal Arteries - anatomy & histology; Meningeal Arteries - pathology; Meningeal Arteries - surgery; Middle Aged; Middle Cerebral Artery - anatomy & histology; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - pathology; Neurosurgery; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Pia Mater - blood supply; Polyvinyls - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Superior sagittal sinus; Nervous system diseases; Dural arteriovenus fistula; Ethyl vinyl alcohol copolymer; Cardiovascular disease; Alcohol; Dural arteriovenous malformation; Congenital disease; Venous disease; Arterial disease; Vascular disease; Case study; Arteriovenous aneurysm; Treatment; Surgery; Embolization; Dimethyl Sulfoxide; Superior saggital sinus; Copolymer; Arteriovenous malformation; Onyx copolymer
• ISSN: 0148-396X; 1524-4040
• 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.